Melanoma do aparelho ungueal

Abstract

RJ. / Head of the histopathology sector of the Santa Casa Dermatology institute, Rio de Janeiro state. 3 Alunos do Curso de Pós-Graduação em Dermatologia. / Students of the Postgraduate program in Dermatology. ©2 0 0 4 by Anais Brasileiros de DermatologiaResumo: O melanoma do aparelho ungueal é apresentação relativamente rara dessa neoplasia, muitas vezes diagnosticada como nevo juncional, hematoma subungueal ou mesmo onicomicose. Esse fato leva a um atraso no diagnóstico e, conseqüentemente, na instituição da terapêutica específica, contribuindo para agravar o prognóstico de uma doença que por si só já é muito agressiva. Os autores relatam um caso de melanoma no primeiro quirodáctilo esquerdo de uma paciente negra com evolução de um ano, ressaltando a importância de avaliar certos critérios clínicos para obter o diagnóstico em fases mais precoces da doença. Palavras-chave: doenças da unha; melanoma; neoplasias.Abstract: Nail apparatus melanoma is a rare presentation of melanoma and may be misdiagnosed as junctional nevus, subungual hematoma or onychomycosis. This fact often leads initially to inappropriate treatment and significant delays in appropriately managing such an aggressive disease. The authors report a case of melanoma on the left thumb of a black patient evolving for a year. Emphasis was placed on the importance of assessing certain clinical characteristics in order to reach an early diagnosis.

Nail apparatus melanoma: a diagnostic opportunity

“…3,5,7 While 2-3% of melanomas in Caucasians are situated in the ungual apparatus, this percentage rises to 15-20% in Afro-Caribbeans. 3 NAM is more commonly seen on the thumb, followed by the hallux and index finger. 3,5,7 …”

“…3 Although there is no current consensus on managing ungual melanoma in situ , surgical excision entails the complete ungual apparatus itself, including the nail plaque, bed and matrix. 8 The resulting defect can be corrected with a partial or total skin graft.…”

“…2 Nail apparatus involvement is even rarer, with an estimated prevalence of 0.7-3.5% of melanomas. 3 …”

“…4-7 Only 2 out of 3 patients with early nail apparatus melanoma seek medical attention, which results in late diagnosis in most cases, leading to worse prognosis than that of cutaneous melanoma. 3,8 Traditional treatment has been the amputation of the affected digit up to the proximal joint. 3 …”

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“…1,2,5,7,9 Hutchinson's sign is always present in the case of subungual melanomas; however, it may be present in Peutz-Jeghers and Laugier-Hunziker syndromes, subungual hematoma, racial pigmentation and AIDS, in association with the use of certain drugs such as minocycline and zidovudine, and in Bowen's disease. 9,10 No treatment is required, since the condition is not associated with systemic diseases or complications. 1,3,4,9 There have been no reports of malignant degeneration.…”