Assessment of Patient Knowledge of Longitudinal Melanonychia: A Survey Study of Patients in Outpatient Clinics

Abstract

Importance: Subungual melanoma (SM) is a rare subtype of cutaneous melanoma but carries a worse prognosis than similarly staged cutaneous melanomas. Assessing patient knowledge of melanonychia is integral to early diagnosis of SM. Objectives: The aim of this paper is to determine patient knowledge of longitudinal melanonychia (LM) and warning signs for SM, frequency of nail self-examinations, and satisfaction of patients with their physician's nail examinations. Design, Setting, and Participants: We conducted a survey-based study of 363 random patients at Weill Cornell Medicine in New York, USA, performed at 3 different clinics: a general dermatology clinic (n = 167), a nail specialty clinic (n = 44), and a primary care clinic (n = 152). Main Outcomes and Measures: Knowledge of the ABCDEF mnemonic for SM was compared to the ABCD mnemonic for cutaneous melanoma. Analyses were performed for patient behavior regarding suspicious nail changes as well as satisfaction with nail counseling and examination. Results: Only 5% (18/363) of the patients in our study had heard of the ABCDEF mnemonic. In contrast, 9.9% (36/363) of the patients had heard of the ABCD mnemonic for cutaneous melanoma. In total, 37/363 (10.2%) patients reported having LM, 32.4% (12/37) of the patients noted changes in color or width of the band, and 10.8% (4/37) presented with pain or bleeding of the nail, with only 45.9% (17/37) seeking medical attention. Only 11.8% (43/363) of the patients stated that their physician asked them about nail changes, and 1.4% (5/363) of the patients stated that they were counseled about the ABCDEF mnemonic. In comparison, 13.8% (50/363) of the patients were advised on the ABCD mnemonic for the cutaneous melanoma mnemonic. While 70.2% (255/363) of the patients stated that they used sunscreen or wore sun-protective clothing, only 31.4% (114/363) assessed their nails for color changes, with 54.9% (128/233) of the patients categorizing themselves as “very unsatisfied” with the evaluation of their nails by their dermatologist. Conclusions and Relevance: Our data shows that there is a lack of patient knowledge of LM and warning signs for SM. Further testing is needed to determine whether educating patients about LM, warning signs for SM, and nail self-examinations would improve patient outcomes.

Dermoscopic features of neoplasms in skin of color: A review

“…However, the high morbidity and mortality associated with nail melanoma highlights the need for recognition of clinical and dermoscopic features that can clue clinicians in to the need for a nail unit biopsy. Moreover, most patients do not recognize nail abnormalities associated with a subungual melanoma ( Halteh et al, 2017 ) and may not present for changes regarding the nail unit. Features of pigmented nail lesions are best appreciated with contact dermoscopy, under polarized light, with the use of gel immersion, such as ultrasound gel ( Braun et al, 2007 ).…”

Retrospective analysis of nail biopsies performed using the Medicare Provider Utilization and Payment Database 2012 to 2017

“…Aggressive tumor behavior, 7,19,20 poor biopsy technique or failure to biopsy in the earliest disease stages, 7,11,21‐29 likely contribute to the poor prognosis associated with SUM. Physicians may lack confidence in performing biopsies in the subungual region due to complex anatomy, lack of formal nail biopsy training and poor familiarity with clinical and dermoscopic of SUM due to the rarity of the disease 3,23,29‐34 . Because risks factors for SUM are unknown, early detection is the currently only way to potentially improve survival and functionality in these patients 24,35,36 …”

“…likely contribute to the poor prognosis associated with SUM. Physicians may lack confidence in performing biopsies in the subungual region due to complex anatomy, lack of formal nail biopsy training and poor familiarity with clinical and dermoscopic of SUM due to the rarity of the disease 3,23,[29][30][31][32][33][34]. …”

Comment on: “The first 30 years of the American Academy of Dermatology skin cancer screening program: 1985-2014”

“…A previous survey-based study found a paucity of patient knowledge on longitudinal melanonychia and the warning signs for subungual melanomas. 3 Only 31% of patients assessed their nails for color changes, and only 13% of patients responded that their doctors asked about nail changes. Another study found that only 8% of physicians asked their patients to remove nail polish at every visit, yet 44% of physicians responded that they encounter melanonychia at least once a month and 23% once a week.…”