Hutchinson's Sign Research Articles

DETECTION OF EARLY LESIONS OF “UNGUAL” MALIGNANT MELANOMA

The nail area is commonly affected by malignant melanoma. The prognosis of malignant melanoma of the nail is poor, because at the time of diagnosis most lesions are in the advanced stage. Correct diagnosis of early lesions could improve the prognosis. For 3 years, all patients with nail pigmentation at the dermatology clinic were screened for five specific criteria for the diagnosis of early lesions of malignant melanoma. Histologic examination was performed on 10 of 29 lesions. Five of the 29 lesions were advanced malignant melanoma, easily diagnosed clinically. Two of the remaining 24 lesions fulfilled most of our clinical criteria of early malignant melanoma of the nail apparatus; that is, they appeared as melanonychia striata during adulthood, were wide in breadth measuring 9 and 11 mm, and showed variegated shades of brown. Periungual pigmented macule (Hutchinson's sign) was observed in one of the two cases. Total resection of the lesions was performed, followed by skin grafting. Histologically, an increased number of atypical melanocytes, mainly arranged as solitary units, were observed only in the epithelia of the nail matrix and of the nail-bed, confirming that these lesions were "ungual" malignant melanoma in situ. Such an early lesion of malignant melanoma of the nail apparatus can be completely cured with conservative excision, and the phalanx of the affected digit can be preserved.

Pregnancy-associated hyperpigmentation: Longitudinal melanonychia

A 32-year-old white woman of Ashkenazi extraction (skin type III) had a longitudinal dark brown streak on the nails of her second and third toes on the right foot during her first pregnancy. The pigmented streaks were uniformly dark brown, 1 to 2 mr:n in width, with sharp borders. Pigmentation of the periungual skin (Hutchinson's sign) was present on the cuticle and proximal nail bed and extended to the proximal and one lateral nail fold. During pregnancy, the patient also noted the development of 15 to 20 brown macules on the anterior aspect oiher torso. The longitudinal melanonychia resolved after delivery and the brown macules on her trunk becamelighter but did not resolve completely. During her second pregnancy, the patient again noted the development of dark brown streaks of the nails of her right second and left third fingers that were 2 and 3 mm wide, respectively (Fig. 1), and on several toenails. She also noted darkening of the macules on her trunk, as well as the development of new macules. These changes were noted during the fifth month of pregnancy. Six months after delivery, the pigmented streaks on the fingernails and two toenails had completely resolved and the macules on her trunk became lighter. A biopsy specimen of a macule on the abdomen was obtained 11 months after delivery. On histologic examination, the epidermis showed elongation of the rete and basilar melanocytic hyperplasia and hyperpigmentation.

Clinical and histopathologic characteristics of early lesions of subungual malignant melanoma.

Twenty-one Japanese cases of subungual malignant melanoma were investigated clinically and histologically. In the majority of the cases, the initial sign of the disease was confirmed to be melanonychia striata. Five cases of Clark's Level I melanoma were found in the series. Melanonychia striata had appeared as the initial sign in these five cases. Melanonychia striata is frequently observed in persons who are not white and is attributed to various local and systemic causes. Detailed clinical analysis of the five cases of early subungual melanoma showed that melanonychia striata with the following characteristics may increase the risk of early subungual melanoma developing: it is noticed during adulthood, it is broader than 6 mm, it is brownish with variegated shades or homogenously black, and it is accompanied by periungual pigmentation (Hutchinson's sign). Detection of early lesions of subungual melanoma is beneficial not only for the improvement of prognosis, but also for the preservation of the affected phalanx.