Melanonychia Research Articles

Pigmented BowenÓ?s disease presenting clinically as longitudinal melanonychia

Pigmented BowenÓ?s disease presenting clinically as longitudinal melanonychia

52239 Clinical and dermoscopic features of Hutchinson’s sign with longitudinal melanonychia: A retrospective cohort study in Korea

52239 Clinical and dermoscopic features of Hutchinson’s sign with longitudinal melanonychia: A retrospective cohort study in Korea

PA21 A child with longitudinal melanonychia secondary to subungual naevus showing regression during treatment with a single-agent MEK inhibitor (trametinib)

PA21 A child with longitudinal melanonychia secondary to subungual naevus showing regression during treatment with a single-agent MEK inhibitor (trametinib)

Dermoscopic features of nails in Leprosy patients in a tertiary referral hospital in West Java, Indonesia

IntroductionLeprosy is a chronic granulomatous infectious disease, mainly affecting the skin and peripheral nerves, caused by the obligate intracellular bacteria Mycobacterium leprae. The disease has been discussed in several review articles in recent research, but as far as we know, only a few have addressed the effects of leprosy on nails, especially those who examine the dermoscopic features of nails in leprosy patients.PurposesWe aimed to document nail changes in leprosy patients and identify any particular findings through dermoscopic examination.MethodThis was an observational study conducted in the Dermatology and Venereology Clinic of Hasan Sadikin Hospital, West Java, Indonesia, from March 2023 through May 2023. All patients have established cases of leprosy, and the diagnosis is based on clinical and bacteriological examinations. Recruitment was done through total sampling. Dermoscopic examination of all fingernails and toenails was performed at 10x magnification using a handheld dermatoscope (Heine DELTA 20 T Dermatoscope) in polarized mode without the linkage fluid to document the dermoscopic features.ResultOf a total of 19 patients, 15 had nail changes due to leprosy. Out of 15 patients, 13 patients were male. Patients below 25 years old had more nail changes. Most of the patients had a duration of disease greater than two years. Both fingers and toes were involved in nine patients. In this study, the most common dermoscopic feature found was the longitudinal ridge. Other dermoscopic features found in this study were transverse lines, onycholysis, longitudinal melanonychia, leukonychia, subungual hemorrhage, subungual hyperkeratosis, anonychia, and onychorrexis.ConclusionNail changes are found in leprosy patients and have a wide variety of clinical appearances. A dermoscopy should be performed to assess nail changes in leprosy.

Onychoscopy and nailfold capillaroscopy in leprosy: A case–control study

Objectives: Studies have reported significant number of individuals with leprosy develop nail changes of heterogeneous variety. Direct or indirect damage secondary to neural damage, repeated trauma, vascular injury, anemia or following drug therapy have been implicated. In this study, we compared nail changes in cases of leprosy with controls to determine leprosy specific nail changes through detailed onychoscopic evaluation along with nailfold capillaroscopy. Materials and Methods: We performed a case–control study in a tertiary care institute with 30 leprosy patients and 30 age- and sex-matched controls. The study was done over a period of three months from June 2023 to August 2023. Patients were classified as per Ridley-Jopling classification. A detailed clinical examination followed by onychoscopy and proximal nailfold (PNF) capillaroscopy using Dermlite DL4 was done in all the nails of cases and controls. Results: A total of 600 nails of 30 leprosy patients on treatment attending our outpatient department were studied over a span of three months. Nail changes were seen in 26 (86.6%) out of 30 patients of leprosy disease compared to 10 (33.3%) of the controls. The most common nail finding seen in leprosy patients was longitudinal melanonychia followed by leukonychia. Transverse lines, leukonychia, subungual hyperkeratosis, nail discoloration, nail pallor, onychochauxis, subungual hematoma, splinter hemorrhage, and brachyonychia were seen more in cases than in controls, and the difference was statistically significant. The PNF capillaroscopy showed microhemorrhages in eight patients of leprosy while none in controls. Conclusion: Nail changes seen in leprosy are multifactorial. The PNF capillaroscopy showed microhemorrhages, which could be an early feature of vascular changes in leprosy.

Prevalence and onychoscopy features of benign longitudinal melanonychia in richly pigmented skin individuals

Prevalence and onychoscopy features of benign longitudinal melanonychia in richly pigmented skin individuals

Looking Beyond the Hutchinson Sign: A Retrospective Study of Clinical Factors Indicating the Presence and Invasiveness of Nail Unit Melanoma in Patients With Longitudinal Melanonychia.

The data underlying this article are available in the article.Longitudinal melanonychia (LM) presents a challenge because nail unit melanoma (NUM) must be considered as a differential diagnosis. Because nail matrix biopsy may result in nail dystrophy, it is important to distinguish NUM from LM. To provide evidence of previously reported clinical factors indicative of NUM in patients with LM. This was a retrospective study of patients who presented with LM and had biopsy-confirmed NUM from 2005 to 2021. Benign LM was either confirmed by biopsy or considered benign if followed without the need for biopsy. Clinical factors associated with LM and NUM were compared by multivariate regression. A total of 177 patients (97 LM and 80 NUM) were included. Multivariate regression showed that high band color intensity (p = .0031), variegation (p = .0005), nail plate splitting (p = .0017), Hutchinson sign (p = .0027), and band change (p = .001) correlated with malignancy. Nail plate splitting was associated with Breslow thickness. Malignancy should be suspected and biopsy performed in patients with LM and high band color intensity, variegation, nail plate splitting, Hutchinson sign, and band change.

Clinicopathological and prognostic features of subungual melanoma in situ

Objective: To investigate the clinicopathological characteristics, immunohistochemical profiles, molecular features, and prognosis of subungual melanoma in situ (SMIS). Methods: Thirty cases of SMIS were collected in Fudan University Shanghai Cancer Center, Shanghai, China from 2018 to 2022. The clinicopathological characteristics and follow-up data were retrospectively analyzed. Histopathologic evaluation and immunohistochemical studies were carried out. By using Vysis melanoma fluorescence in situ hybridization (FISH) probe kit, combined with 9p21(CDKN2A) and 8q24(MYC) assays were performed. Results: There were 8 males and 22 females. The patients' ages ranged from 22 to 65 years (median 48 years). All patients presented with longitudinal melanonychia involving a single digit. Thumb was the most commonly affected digit (16/30, 53.3%). 56.7% (17/30) of the cases presented with Hutchinson's sign. Microscopically, melanocytes proliferated along the dermo-epithelial junction. Hyperchromatism and nuclear pleomorphism were two of the most common histological features. The melanocyte count ranged from 30 to 185. Most cases showed small to medium nuclear enlargement (29/30, 96.7%). Pagetoid spread was seen in all cases. Intra-epithelial mitoses were identified in 56.7% (17/30) of the cases. Involvement of nailfold was found in 19 cases, 4 of which were accompanied by cutaneous adnexal extension. The positive rates of SOX10, PNL2, Melan A, HMB45, S-100, and PRAME were 100.0%, 100.0%, 96.0%, 95.0%, 76.9%, and 83.3%, respectively. FISH analysis was positive in 6/9 of the cases. Follow-up data were available in 28 patients, and all of them were alive without disease. Conclusions: SMIS mainly shows small to medium-sized cells. High melanocyte count, hyperchromatism, nuclear pleomorphism, Pagetoid spreading, intra-epithelial mitosis, nailfold involvement, and cutaneous adnexal extension are important diagnostic hallmarks. Immunohistochemistry including SOX10 and PRAME, combined with FISH analysis, is valuable for the diagnosis of SMIS.

Nail Whispers Revealing Dermatological and Systemic Secrets: An Analysis of Nail Disorders Associated With Diverse Dermatological and Systemic Conditions.

Background and objective Nail disorders encompass a wide spectrum of conditions, spanning congenital, developmental, infectious, neoplastic, degenerative, dermatological, and systemic diseases. A comprehensive exploration of their clinical manifestations, incidence, and associations is crucial for precise diagnosis and effective management. Methods This observational cross-sectionalstudyconducted atB.J. Medical College and Civil Hospital,Ahmedabad involved 300 consecutive patients with nail changesfrom July 2017 to June 2019 reporting diverse dermatological and systemic conditions. The inclusion criteria involved patients of both genders and all age groups displaying nail changes associated with dermatological and systemic diseases. Data collection entailed a comprehensive clinical history, systemic and dermatological examinations, nail assessment using Dermoscope (DermLite 3, 10x), and supplementary tests. Analyses were performed on Microsoft Excel 2007 software. The studywas approved by the Institute Ethics Committee. Results Among the300 cases, females had a higher prevalence of nail involvement (57%), with a female-to-male ratio of 1.3:1. The most affected age group was 21-40 years, with 6-10 nails typically affected. Notably, housewives showed a higher prevalence. The most frequent nail condition was onychomycosis (24.33%) followed by psoriatic nail changes (20%).Less frequent nail changes involved eczema (5.7%), paronychia (5%), drug-induced (4.3%), lichen planus (3.7%), trauma-induced (3%), twenty nail dystrophy (2.33%), Darier's disease (2%), pemphigus vulgaris (2%), alopecia areata (1.67%), median Heller dystrophy (1.33%), atopic dermatitis (1%), epidermolysis bullosa (1%), racquet nail (1%), leprosy (1%), pityriasis rubra pilaris (0.67%), vitiligo (0.67%), secondary syphilis (0.67%), pachyonychia congenita (0.67%), as well as a case each of total leukonychia, subungual warts, Koenentumor, and periungual fibroma(0.33%). Systemic autoimmune connective tissue disorders (CTD) accounted for 9%; the most common nail finding observed was nail fold erythema (48.1%) followed by nail fold telangiectasis (44.4%). In systemic sclerosis (SS), the most common finding was nail fold telangiectasia, and in systemic lupus erythematosus (SLE), the most common was nail fold erythema. Scleroderma capillary pattern on nail fold capillaroscopy was found in seven patients with SS, two patients with dermatomyositis, and only one patientwith SLE. Nail changes observed in systemic diseasesinclude onychomycosisin diabetes mellitus and chronic renal failure patients, splinter hemorrhagesin ischemic heart disease and hypertension, longitudinal melanonychia in HIV,and koilonychia and platynychia in iron deficiency anemia.Other systemic diseases, such asAddison's disease and renal failure, also exhibited various nail changes. Conclusions Beyond their cosmetic importance, nails hold a vital pathologic role. Proficiency in nail terminology and classification is key for skillful evaluation. Understanding normal and abnormal nail variants, along with their disease associations, benefits diagnosis and tailored management. Nails, often overlooked but accessible, serve as a window into patients' general health and should be an integral part of thorough examinations.This study highlights an intricate clinical panorama of nail disorders, highlighting their significant role in both dermatological and systemic contexts.

Concurrence of longitudinal melanonychia and numbness in a patient with left hemiparesis suffering from thumb injury by clamp during performing occupational therapy

Numbness within the thumb involving the palmar aspect with the three and a half digits as the division is a common presentation of peripheral nerve injury. However, it is rarely observed to be presented with numbness at half of the ulnar-palmar side of the thumb, where the longitudinal melanonychia on the nail plate acts as the division. We present a case that reveals concurrence of longitudinal melanonychia and numbness suffered from a thumb injury during the course of occupational therapy.

Melanonychia and subungual papule in a middle-aged man

Melanonychia and subungual papule in a middle-aged man

Adult and Pediatric Nail Unit Melanoma: Epidemiology, Diagnosis, and Treatment

Nail unit melanoma (NUM) is an uncommon form of melanoma and is often diagnosed at later stages. Approximately two-thirds of NUMs are present clinically as longitudinal melanonychia, but longitudinal melanonychia has a broad differential diagnosis. Clinical examination and dermoscopy are valuable for identifying nail findings concerning malignancy, but a biopsy with histopathology is necessary to confirm a diagnosis of NUM. Surgical treatment options for NUM include en bloc excision, digit amputation, and Mohs micrographic surgery. Newer treatments for advanced NUM include targeted and immune systemic therapies. NUM in pediatric patients is extremely rare and diagnosis is challenging since both qualitative and quantitative parameters have only been studied in adults. There is currently no consensus on management in children; for less concerning melanonychia, some physicians recommend close follow-up. However, some dermatologists argue that the "wait and see" approach can cause delayed diagnosis. This article serves to enhance the familiarity of NUM by highlighting its etiology, clinical presentations, diagnosis, and treatment options in both adults and children.

Clinical and histopathologic features of pediatric longitudinal melanonychia: A multicenter retrospective study

Clinical and histopathologic features of pediatric longitudinal melanonychia: A multicenter retrospective study

Common nail diseases in children and adolescents : Recognize, advise, treat

There are anumber of nail diseases that primarily occur in children and adolescents. Many of these nail changes are physiologic and are only transient. Thus, they do not need any therapy. Infectious nail diseases or nail involvement in chronic inflammatory dermatoses can be found in both children and adults, and may require specific treatment. Nail pigmentation such as longitudinal melanonychia occur significantly less frequently in children than in adult patients, and have different causes and abetter prognosis. Knowledge about these child-specific peculiarities of nail diseases is necessary in order to provide the best possible advice to parents and to offer appropriate treatment. This article focuses on the most common and important nail diseases in children and adolescents and their treatment.

Journal Club: Longitudinal melanonychia in children: keep calm, wait and see.

Journal Club: Longitudinal melanonychia in children: keep calm, wait and see.

Retrospective analysis of longitudinal melanonychia: A Chinese experience.

We aimed to analyze the clinical and histopathologic characteristics of longitudinal melanonychia (LM), explore the differences between adults and children, and propose some recommendations. Data on pigmentation, lentigo, subungual melanoma (SUM), and nail matrix nevus (NMN) were acquired for comparison. Lesions on thumbs in the children's group were significantly fewer (p = 0.006) than in adults. Lesions on little fingers in children were more than in adults; the difference was statistically significant (p = 0.025). The widths of bands in adults were wider than in children (p < 0.001), and the duration and width were positively correlated (r = 0.474). There was more pigmentation in adults than in children; the difference was statistically significant (p = 0.005). NMN was reported in 56.1% children and 34.3% adults; the difference was statistically significant (p = 0.005). Adults had six SUM cases, whereas none in children; the difference was statistically significant (p = 0.006). The recurrence rate in adults was significantly higher than in children (p = 0.019). The widths of bands increase with the course, indicating that LM may be progressive. The four pathological types have different distributions with age, and each type requires different treatment. The lower recurrence rate in children suggests that LM needs diagnosis and appropriate treatment as soon as possible.

Mucocutaneous Findings in Hematolymphoid Neoplasms: An Observational Study.

Cutaneous manifestations of hematological neoplasms can be divided into three broad categories - direct infiltration, paraneoplastic conditions, and those due to the treatment of hematological cancers. To study the frequency and patterns of mucocutaneous manifestations in patients with hematolymphoid neoplasms and those due to chemotherapy. This was an observational study done with 172 patients. Categorization of mucocutaneous manifestations was done into malignancy-associated and chemotherapeutic drugs-associated and data was analyzed. Out of a total of 172 patients, 15.6% (27/172) had malignancy-related mucocutaneous manifestations. Among these, 4.6% (8/172) had direct infiltration of malignant cells into the skin and 11% (19/172) had paraneoplastic manifestations. The most common chemotherapy-related mucocutaneous manifestations were nail changes - 47.1% (81/172), of which transverse melanonychia was the most common (20.9%). About 44.2% (76/172) had a cutaneous infection, the commonest of which was a fungal infection (15.1%). Chemotherapy-induced alopecia was noted in 46.5% (80/172) and found to be significantly associated with cytarabine, daunorubicin, doxorubicin, methotrexate, and vincristine. Cutaneous hyperpigmentation was found to be significantly associated with cytarabine, doxorubicin, and vincristine. Mucocutaneous manifestations cause additional discomfort to a patient undergoing chemotherapy. Early recognition and timely and appropriate management facilitate symptom control and prevent treatment-related morbidity. A multidisciplinary approach involving hemato-oncologists and dermatologists can help achieve this target.

A Case of Longitudinal Melanonychia in A Child: Benign or Malignant?

Background: Longitudinal melanonychia (LM) describes a longitudinal brown-to-black band of discoloration affecting a finger, thumb, or toenail. Discoloration of the nails can be a sign of benign or malignant nail disorders. Although nail melanoma rarely occurs in children, health practitioners should be aware of melanonychia. Dermoscopy and histopathology are helpful in the diagnosis. Case Illustration: A case of LM in a thirteen-year-old girl was reported with a complaint of brownish-black discoloration, sometimes painful, on her right thumb since 1 year ago. She had no history of trauma, nail damage, or bleeding tendency. Dermatological examination found a homogeneous brownish-black band on the right thumbnail. Dermoscopy revealed regular, homogeneous black linear pigmentation and pigment through the translucent cuticle and proximal nail fold (pseudo-Hutchinson’s sign). Punch biopsy was done on proximal nail fold reaching nail matrix. Histopathology revealed increased melanocytes, some nests of melanocytes in rete Malpighi, and no atypical cells. She was diagnosed with nail matrix nevus. Five months after the punch biopsy, the nail grew well without onychodystrophy. Discussion: Nail matrix nevus is a benign LM. Diagnosis is based on anamnesis, physical examination, dermoscopy, and histopathology. Dermoscopy of the nails is a useful, quick, non-invasive, and highly effective tool that may help differentiate benign or malign melanonychia. Conclusion: Histopathology is important to determine whether the pigmented lesion is benign or malignant.

A Case of Longitudinal Melanonychia in A Child: Benign or Malignant?

Background: Longitudinal melanonychia (LM) describes a longitudinal brown-to-black band of discoloration affecting a finger, thumb, or toenail. Discoloration of the nails can be a sign of benign or malignant nail disorders. Although nail melanoma rarely occurs in children, health practitioners should be aware of melanonychia. Dermoscopy and histopathology are helpful in the diagnosis.

Longitudinal melanonychia in a 13-year-old Caucasian boy

Longitudinal melanonychia in a 13-year-old Caucasian boy