Nail changes can be a common side effect of many chemotherapy agents. Changes can include nail discolouration, nail ridging, onycholysis, paronychia and nailbed pyogenic granulomas. These changes are most commonly associated with taxane chemotherapy agents (e.g. paclitaxel) affecting up to 51% of patients on treatment. Paronychia and nailbed pyogenic granulomas can impact self-care activities of daily living (ADLs) when affecting the hands, and be an impediment to walking when affecting the feet. Medical management (analgesia, antiseptic baths, trimming onycholytic nail plates, application of topical steroid cream, oral antibiotics) has its role in early paronychia. However, more advance disease (purulent paronychia and nailbed pyogenic granuloma) may require surgical treatment to avoid reduction (or cessation) of the chemotherapy agent. Despite this, there is no published evidence on the outcome of surgical management for taxane induced nail complications. We present the case of a 43-year-old female on adjuvant paclitaxel and Herceptin for breat cancer. She was referred to our surgical service with bilateral hand, and then bilateral feet paclitaxel induced onychomycosis, paronychia and nailbed pyogenic granulomas. She had already completed two courses of oral antibiotics without improvement. We performed a mixture of surgical interventions in a single stage – individualised to the severity of each digit - to successfully treated our patient without recurrence at three months. Alongside the pictorial review, management and outcome of our case, we will discuss the staging and different treatment strategies offered by the literature and how surgeons can play a role in management this potentially debilitating side effect.