A Novel Window Technique Using CO2 Laser, and a Review of Methods for Nail Matrix Biopsy of Longitudinal Melanonychia

Ohn, Jungyoon; Jo, Gwanghyun; Chae, Je Byeong; Mun, Je‐Ho

doi:10.1097/dss.0000000000001381

Cited by 8 publications

(6 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Therefore, the authors used a specialized window technique with punch biopsy that targets only the nail matrix where the main pathologic change occurs. This is a variant technique that we used for longitudinal melanonychia 10 …”

Section: Discussionmentioning

confidence: 99%

Histopathologic findings of idiopathic trachyonychia: An analysis of 30 adult patients

et al. 2020

View full text Add to dashboard Cite

Background Trachyonychia, a rare inflammatory disease of the nail matrix, has a more chronic course in adults compared with that in children. However, the histopathologic features of the disease have not been sufficiently reported in the literature. Methods We retrospectively reviewed the pathologic features of idiopathic trachyonychia in adult cases at our center. Results A total of 30 cases were included. The median age was 55.5 years (range, 27‐77 years). Median disease duration was 84 months (range, 8‐384 months). Histopathologic analysis showed upper dermal lymphocytic infiltrates (93.3%), acanthosis (86.7%), exocytosis (63.3%), spongiosis (63.3%), parakeratosis (46.7%), psoriasiform hyperplasia (40%), eosinophilic infiltrates (33.3%), vacuolar degeneration (33.3%), lichenoid pattern (13.3%), Civatte body (6.7%), and collection of neutrophils in the stratum corneum (3.3%). Statistical analysis among pathologic parameters revealed associations of spongiosis with exocytosis (P < 0.001) and lichenoid infiltration with vacuolar degeneration (P = 0.008). Three patients (10%) showed fungal co‐infection. Conclusion The majority of cases revealed inflammatory cell infiltration with epidermal changes. Given the inflammation and chronic course of idiopathic trachyonychia in adulthood, active treatment with anti‐inflammatory agents should be considered. Additionally, mycological tests should be considered during initial evaluation as there are cases with fungal coinfection.

show abstract

Section: Discussionmentioning

confidence: 99%

Histopathologic findings of idiopathic trachyonychia: An analysis of 30 adult patients

et al. 2020

View full text Add to dashboard Cite

show abstract

“…This procedure can be performed by first using a 4–6 mm punch to remove the nail plate, following which physicians can perform a smaller punch (2–4 mm) to acquire the nail matrix tissue 14 . Although the technique is simple, there is a risk of obtaining false‐negative results, as the pigmented patterns in the matrix cannot be thoroughly identified during the procedure 48 …”

Section: Diagnosismentioning

confidence: 99%

“…14 Although the technique is simple, there is a risk of obtaining false-negative results, as the pigmented patterns in the matrix cannot be thoroughly identified during the procedure. 48 When pigmented bands are located in the lateral third of the nail plate, a lateral longitudinal nail biopsy can be performed. The excision extends from the most proximal aspect of the nail matrix to the digit pulp.…”

Section: Biopsy Techniquesmentioning

confidence: 99%

“…50,52 A recent study offered a novel window technique using CO 2 laser as an alternative nail matrix biopsy method for LM. 48 Besides, a technique combining the longitudinal-strip nail window technique with modified shave surgery has been shown to have limited postoperative nail dystrophy (25%) and minimal recurrence of pigmentation (13%). 53…”

Section: Biopsy Techniquesmentioning

confidence: 99%

See 1 more Smart Citation

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

Darmawan

Ohn

Mun

et al. 2022

Acad Dermatol Venereol

View full text Add to dashboard Cite

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 in situ 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.

show abstract

“…[7][8][9] The nail window technique assisted by a CO 2 laser is an auxiliary method before nail surgery that creates a window on the nail plate and makes exposure of the pigmented nail matrix easier. 10 A previous study has shown that the rate of recurrence of nail pigmentation was as high as 70% after tangential excision of pigmented nail matrix lesions responsible for LM. 8 This may due to an incomplete excision of the responsible lesions or repopulation of the melanocytes from the ventral surface of the pigmented nail plate.…”

mentioning

confidence: 96%

Modified shave surgery combined with nail window technique for the treatment of longitudinal melanonychia: Evaluation of the method on a series of 67 cases

Zhou

Chen

Liu

et al. 2019

Journal of the American Academy of Dermatology

View full text Add to dashboard Cite

Background: Nail matrix histopathologic examination is still the criterion standard to diagnose longitudinal melanonychia (LM). Objective: To introduce modified shave surgery combined with the nail window technique for managing LM and evaluate the postoperative outcome of the procedure. Methods: We retrospectively reviewed the medical records of 67 patients with LM who underwent shave surgery combined with the longitudinal-strip nail window technique at our institution from March 2015 to June 2018. Results: Pathologic diagnosis was accessible in all cases, and 60 cases were assessable for the postoperative outcomes. A total of 45 cases (75.0%) had no postoperative nail dystrophy, and recurrence of nail pigmentation was found in only 8 cases (13.3%). Limitations: This was a retrospective study. Conclusion: Modified shave surgery combined with the nail window technique is the preferable management for LM cases, with limited postoperative nail dystrophy and recurrence of pigmentation. (J

show abstract

A Novel Window Technique Using CO2 Laser, and a Review of Methods for Nail Matrix Biopsy of Longitudinal Melanonychia

Abstract: The window technique assisted by CO2 laser and dermoscopy can be a minimally invasive and effective method for nail matrix LM biopsy under local anesthesia.

Cited by 8 publications

References 21 publications

Histopathologic findings of idiopathic trachyonychia: An analysis of 30 adult patients

Histopathologic findings of idiopathic trachyonychia: An analysis of 30 adult patients

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

Modified shave surgery combined with nail window technique for the treatment of longitudinal melanonychia: Evaluation of the method on a series of 67 cases

Contact Info

Product

Resources

About