Abstract
A 50-year-old white woman presents with subungual and acral pigmentationof the leftmiddle finger.She firstnoticedablackstreakdown themiddleof hernail 10yearsprior topresentation. Subsequently, the pigmented band on the nail plate widenedanddarkened,withpigmentspreading to theproximal nail fold anddistal acral hyponychial skin. She has no associated symptoms, including nail splitting, bleeding, orpain, andnohistoryof acuteor recurrent trauma. Several years previously, shewas reassured that her nail pigmentation was benign. The nail examination is illustrated in the Figure. Examination of all other nails is unremarkable. Past medical history and family history are unrevealing. Quiz at jama.com A B
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