Nail Melanoma Research Articles

JAAD Game Changers: Functional surgery versus amputation for in situ or minimally invasive nail melanoma: A meta-analysis

JAAD Game Changers: Functional surgery versus amputation for in situ or minimally invasive nail melanoma: A meta-analysis

Various Free Flap Reconstruction Techniques after Hand and Foot Melanonychia Ablation: A Case Series.

(1) Purpose: The management of melanonychia is highly controversial. With growing melanonychia, in case of doubt, the entire lesion should be examined. It may appear similar to nail melanoma or may turn into melanoma. Here, we present surgical cases of nail bed total removal and free flap reconstruction. (2) Methods: Between 1 January 2020 and 31 December 2022, eleven patients were operated on for growing melanonychia, involving the hand and foot. After complete resection of the nail root and plate, immediate reconstruction was performed using a fasciocutaneous free flap. The authors describe the procedures in detail with a few illustrations and clinical photographs depicting the techniques. (3) Results: All patients underwent complete nail unit removal around the anatomic boundaries of the nail. Histology showed a nevus and no malignancy in all cases. We used three onychocutaneous flaps, three hypothenar flaps and five venous flaps. All flaps survived, with one case of partial necrosis which spontaneously healed with secondary intention. In the follow-up periods, there was no recurrence or nail regrowth. (4) Conclusions: These free flap techniques are very useful for total nail bed defect reconstruction after melanonychia lesion total ablation.

Onychocytic Matricoma: A Clinical, Dermoscopic, and Pathological Analysis of 14 Cases.

Onychocytic matricoma (OCM) is a benign neoplasm of the nail matrix. Only 18 cases of this tumor have been reported in the literature to date. We retrospectively analyzed the clinical features of 14 patients with OCM. The most common clinical feature was longitudinal xanthopachyonychia (n = 9), followed by longitudinal leukopachyonychia (=3) and longitudinal pachymelanonychia (n = 2). The most common clinical findings identified following dermoscopy and analysis at high magnification of classical photographs were free-edge thickening of the nail plate without pitting (n = 14), longitudinal ridging (n = 7), round white clods (n = 7), white dots (n = 7), and filiform hemorrhages (n = 7), followed by oval and linear white clods (n = 5), fuzzy lateral border (n = 5), and red-purple blood clods (n = 3). Nail clipping histopathology showed a thickened nail plate with multiple, small, round-to-oval spaces. The tumor expressed immunopositivity for LEF-1. Dermoscopy of the nail plate and nail clipping histology provides useful information with regards to the differential diagnosis with subungual squamous cell carcinoma and nail melanoma. Ex vivo-in vivo correlation facilitates a better dermoscopic assessment of this unique underrecognized disease. However, the differential diagnosis between OCM and onychocytic carcinoma requires biopsy of the tumor. LEF-1 as an onychogenic marker can be used to resolve the differential diagnosis between OCM and subungual longitudinal acanthoma/seborrheic keratosis.

Transfer learning-based quantized deep learning models for nail melanoma classification

Transfer learning-based quantized deep learning models for nail melanoma classification

Diagnosis and treatment of subungual melanoma

Subungual melanoma (SM) must be suspected in the initial workup of patients with pigmented nails. However, the differential diagnosis of SM from other nail disorders that involve nail pigmentation is challenging. Dermoscopic, clinical, and histopathological features are integrated for a definite diagnosis. The primary treatment of SM is surgery. Depending on the depth of invasion, amputation or functional surgery can be chosen. This article reviews the clinical, dermoscopic, and histopathological features of SM, as well as its diagnosis and treatment.

The Histopathologic Evaluation of Diagnostic Procedures in Nail Melanoma.

The diagnostic delay in nail melanoma (NM) has been repeatedly emphasized. It may be related to both clinical misinterpretations and to errors in the bioptic procedure. To assess the efficacy of histopathologic examination in different diagnostic biopsies in NM. We retrospectively investigated the diagnostic procedures and histopathologic specimens referred to the Laboratory of Dermatopathology for the clinical suspicion of NM from January 2006 to January 2016. Eighty-six nail histopathologic specimens were analyzed consisting in 60 longitudinal, 23 punch and 3 tangential biopsies. A diagnosis of NM was performed in 20 cases, benign melanocytic activation in 51 cases and melanocytic nevi in 15 patients. Longitudinal and tangential biopsy were diagnostic in all cases, regardless of the clinical suspicion. Nail matrix punch biopsy instead was not diagnostic in most of the cases (13/23 specimens). In the presence of an NM clinical suspicion, longitudinal biopsy is recommended (lateral or median) because it provides exhaustive information on the characteristics of melanocytes morphology and distribution in all the components of the nail unit. Tangential biopsy, recently encouraged by expert authors due to the optimal surgical outcome, in our experience gives incomplete information on tumor extension. Punch matrix biopsy gives limited evidence in the diagnosis of NM.

1218 Diagnostic performance for nail melanoma of melanin degradation products in the nail plate

1218 Diagnostic performance for nail melanoma of melanin degradation products in the nail plate

Dermoscopy of Onychomycosis: A Systematic Review.

Onychomycosis represents a global burden accounting for about 50% of nail consultations. Several studies have tried to assess the dermoscopic features of onychomycosis. With the multiplication of papers, several "new" dermoscopic signs keep being added leading to some inconsistency in onychoscopic terminology. This study aimed to summarize the existing literature on the dermoscopic features of onychomycosis and propose a unified onychoscopic terminology. The literature search was performed using PubMed and Scopus databases up to October 30, 2021 to identify eligible contributions. In total, 33 records (2111 patients) were included. The main dermoscopic signs of onychomycosis are "ruin appearance", "longitudinal striae" and "spikes" on the proximal margin of onycholytic areas, with a specificity of 99.38%, 83.78%, and 85.64% respectively. The "aurora borealis" sign had the highest sensitivity and specificity. The current review provides a framework for issues related to the onychoscopic terminology of onychomycosis and is intended to serve as an aid for students, teachers, and researchers. We proposed a unifying terminology to describe dermoscopic signs of onychomycosis. Dermoscopic signs of onychomycosis show good specificity and are useful in distinguishing nail psoriasis, trauma, and onychomycosis. It helps differentiate fungal melanonychia from nail melanoma, nevi, and melanocytic activation.

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.

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.

Dermatomyositis Triggered by Metastatic Subungueal Melanoma: A Case Report and Review of Literature

Dermatomyositis (DM) is an idiopathic inflammatory myopathy characterized predominantly by cutaneous and muscular abnormalities that can be associated with neoplasia. The association of dermatomyositis with nail melanoma is very rare, if not exceptional. We report the case of a paraneoplastic dermatomyositis due to an undiagnosed subungueal melanoma in a 70-year-old patient.

Diagnosis and treatment of nail melanoma: a review of the clinicopathologic, dermoscopic, and genetic characteristics.

Nail melanoma (NM) is an important differential diagnosis in patients with longitudinal melanonychia. However, diagnosis is often challenging as it is difficult to differentiate from other pigmented nail disorders. The main challenge for diagnosis is obtaining adequate nail matrix biopsy specimens for histopathological assessment. Furthermore, the histopathological changes in the early stages of NM are subtle and contribute to a delay in diagnosis and care. Therefore, the integration of clinical and histopathological analyses is essential. Clinical and dermoscopic features, such as a broadened width of asymmetric bands in an irregular pattern, with multicolour pigmentation, periungual pigmentation, and continuous growth, are features that support the diagnosis of NM. The essential histological features that must be assessed are cellular morphology, architectural features, melanocyte density, and inflammatory changes. The reported mutations in NMs were BRAF (0-43%), NRAS (0-31%), KIT (0-50%), NF1 (0-50%), and GNAQ (0-25%). Surgery is the primary treatment for NM. The recommended treatment for insitu or minimally invasive NM is functional surgery, but cases with suspected bone invasion should be treated with amputation. Targeted therapy and immunotherapy are indicated for advanced stages of NM. This review summarizes the updated guidelines for the diagnosis and treatment of NM.

Evaluation of a community education tool for detection of nail melanoma by nail salon technicians

Evaluation of a community education tool for detection of nail melanoma by nail salon technicians

Nail Mélanoma

Melanoma is originating from melanocytes, it is a malignant tumor with high metastatic potential. It is the leading cause of moratlity from skin cancer, Nail melanoma is a rare form of malignant melanoma. we report a new case of this rare localization

Ungueal melanoma and a generalized vitiligo: Is this a rare association?

We report an observation of a good prognosis ungual melanoma showed up 10 years after the onset of a generalized vitiligo. It’s a 66ans years old male, with a history of a rapidly progressing vulgar vitiligo showed up 10 years earlier. The patient has been referred to us for the management of a nail melanoma, retained on clinical and histological data, with a vitiligo extended to 70% Body Surface Area. The assessment of locoregional and distant extension was without abnormalities. Several authors have reported the association of vitiligo and other autoimmune disorders, non-melanoma skin cancers, or as part of a particular syndrome. The association of ungueal melanoma and generalized vitiligo was rarely reported in literature. Across this observation, we illustrate that The association of cutaneous melanoma and vitiligo is not rare and may be a factor of good prognosis.

Dermatophytic melanonychia: A case series of an increasing disease.

Melanonychia refers to brown-black colour pigmentation due to melanin or not-melanin deposition in the nail plate. Onychoscopy allows to distinguish if the pigmentation is due by melanin or not. The main causes of non-melanic pigmentation are subungual haematoma and pigmented onychomycosis. Fungal melanonychia (FM) is rare and may present as diffuse or longitudinal pigmentation. Differential diagnosis includes melanic activation, such as ethnic-type nail pigmentation or frictional melanonychia, but also versus melanic proliferation, such as nevus or nail melanoma. Fungal melanonychia can be due to a colonisation by fungi with black variant or by melanin activation due to inflammation of fungal invasion. The aim of paper is to increase clinical and dermoscopic knowledge of this increasingly frequent disease. In this retrospective observational study, twenty patients with dermatophytic melanonychia were collected, with available clinical and dermoscopic pictures. The diagnosis of dermatophytic melanonychia was made based on clinical manifestation and mycological examination. KOH smear was performed in all cases. For each patient, clinical data included: age, gender, type of melanonychia and involved fingers. This study aimed to show increased incidence of dermatophytic melanonychia and its correct management. In addition, we reviewed our collected cases and described the clinical and dermoscopic features of dermatophytic melanonychia. The results of this study showed that physicians should keep in mind the diagnosis of this increasing disease, and that it cannot be performed relying only on clinical grounds. We would like to highlight the importance of tools as KOH examination, culture and dermoscopy.

Smart Image Follow-Up of Black Pigmentation on the Nail With Convolutional Neural Networks

Background: It is a common reason for many patients to consult the dermatologists about black pigmentations on the nail because it maybe be related to the life-threatening malignant disease-melanoma. Although the incidence of nail melanoma is not too high, unfortunately, it is usually diagnosed at a later stage than at the other body sites and directly leads to a worse prognosis. Methods: We have built the dataset which contains 550 standard, high-quality nail dermoscopy images from the outpatients. Relying on the dataset, we created an intelligent analysis system based on deep learning image segmentation. Meanwhile, we realized the quantitative calculation of black pigmentation on the features of shape, color, area and other indicators according to the clinical ABCDEF criteria to achieve medically interpretable index analysis. Findings: Nail image segmentation model has a significant segmentation effect on the target area. The result of index analysis on 5 representative black line images may indicate that the black line is a benign lesion. Comparing the sample images with the quantitative indicators, our intelligent analysis system showed reliablity and interpretability. Interpretation: We developed a deep learning model based on the segmentation model to quantified multiple indexes of the ABCDEF rule. The intelligent analysis system can be helpful to analyze the dynamic index changes of black pigmentations on the nail, which is of significant aid in clinical diagnosis of subungual melanoma. Funding Information: None. Declaration of Interests: Authors declare no Conflict of Interests for this article. Ethics Approval Statement: This research has got the ethics committee approval from the Fifth Affiliated Hospital, Sun Yatsen University and its protocol number is [2021](K225-1).

The tumor genetics of acral melanoma: What should a dermatologist know?

Dermatologists stand at the gateway of individualization of classification, treatment, and outcomes of acral melanoma patients. The acral melanoma genetic landscape differs in vital ways from that of other cutaneous melanomas. These differences have important implications in understanding pathogenesis, treatment, and prognosis. The selection of molecularly targeted therapy must be adapted for acral melanoma. It is also critical to recognize that tumor development is far more complex than an isolated event, reliably treated by a medication acting on a single target. Tumors exhibit intratumor genetic heterogeneity, metastasis may have different genetic or epigenetic features than primary tumors, and tumor resistance may develop because of the activation of alternative genetic pathways. Microenvironmental, immune, and epigenetic events contribute and sustain tumors in complex ways. Treatment strategies with multiple targets are required to effectively disrupt the tumor ecosystem. This review attempts to translate the current molecular understanding of acral melanoma into digestible concepts relevant to the practice of dermatology. The focus is tumor genetics defining potentially treatable cancer pathways, contextualized within the relevant pathologic and molecular features.

Secondary Intention Healing After Functional Surgery for in Situ or Minimally Invasive Nail Melanoma.

Secondary Intention Healing After Functional Surgery for in Situ or Minimally Invasive Nail Melanoma.

Functional surgery versus amputation for in situ or minimally invasive nail melanoma: A meta-analysis

Evidence on whether functional surgery is not inferior to amputation for the treatment of in situ or minimally invasive (Breslow thickness ≤0.5mm) nail melanoma is limited. To investigate the difference in local recurrence between the 2 interventions for in situ or minimally invasive nail melanoma using available published studies. We performed systematic search on PubMed, Embase, Cochrane Library, trial registers, and grey literature databases from inception to June 28, 2018. We included observational studies with at least 5 patients with in situ or minimally invasive nail melanoma. Main outcome was local recurrence. The odds ratio synthesized from 5 studies including 109 patients (88 functional operations and 21 amputations) was 1.57 (95% confidence interval, 0.31-8.00). Small sample size and possible interstudy heterogeneity. Our meta-analysis revealed no difference in local recurrence between the 2 interventions. Considering the functional deficit after amputation, conservative surgery should be the treatment of choice for in situ or minimally invasive nail melanoma.