Nail apparatus melanoma: a diagnostic opportunity

Abstract

Malignant Melanoma is a high mortality neoplasm. The involvement of the nail apparatus is rare, with only 2 out of 3 patients seeking medical attention as the result of recent nail melanocytic lesions. This results in late diagnosis and a prognosis worse than cutaneous melanoma. We report a female, presenting with ulcerative lesions with clinical and laboratory features compatible with leishmaniasis. On return after treatment initiation a longitudinal melanonychia was observed on her first right finger. Biopsy of the nail matrix was performed. Histopathology was compatible with melanoma in situ. Longitudinal melanonychia is not a specific sign for melanoma and it is important that the dermatologist should identify the suspect lesions correctly. The incidental diagnosis of nail melanoma in situ in our case significantly impacted the patient's survival.

The causes of nail apparatus pigmentation presenting to a melanoma screening clinic a prospective study

“…The pigmented bands are due to melanocyte activation, and continuous nail growth is usually seen in nail matrix naevi, benign melanocytic hyperplasia, inflammatory/traumatic or iatrogenic causes (oral medications). Longitudinal melanonychia is therefore not a specific sign for NAMM …”

“…With an annual incidence of 1 per million, NAMM is rare . NAMM is more common among African and Asian ethnic groups with no significant sex difference, and mostly occurs between the fifth and seventh decades …”

“…The diagnosis of longitudinal pigmentation of the nail is often challenging, as it can be a sign of benign conditions . The evolution of the nail pigmentation may offer diagnostic clues and a thorough clinical history is imperative.…”

Melanonychia striata: clarifying behind the Black Curtain. A review on clinical evaluation and management of the 21st century

“…In melanonychia striata due to melanocytic hyperplasia in the nail matrix, dermoscopy often shows a gray background and regular, parallel, longitudinal, homogeneous brown to black lines which are usually darker than those seen in melanonychia striata due to melanocytic activation . The presence of a brown background overlaid by longitudinal lines irregular in their thickness, spacing, color, or parallelism, erosion of the nail plate, and the micro‐Hutchinson sign is highly suggestive of a nail apparatus/subungual melanoma . In patients with any such atypical or concerning features, a nail matrix biopsy for the histologic examination should be considered.…”

Non-traditional melanoma prevention strategies in the young adult and adolescent population

“…Only 66% of patients address melanocytic changes observed in nails [6]. Women will often use nail polish, various gel techniques, and wrapping procedures to conceal nails for prolonged periods of time.…”