Melanonychia – Clues for a Correct Diagnosis

Gradinaru, Teodora C; Mihai, Mara Mădălina; Beiu, Cristina; Tebeică, Tiberiu; Giurcăneanu, Călin

doi:10.7759/cureus.6621

Cited by 9 publications

(14 citation statements)

References 17 publications

(38 reference statements)

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“…Infections and dermatoses like psoriasis may result in melanonychia that typically disappears after the inflammation has resolved. 4 The lack of keratinocyte atypia on histopathology is more consistent with a diagnosis of SCC.…”

Section: Bmentioning

confidence: 82%

“… 1 Hyperpigmentation may not be evident on hematoxylin-eosin stain and often requires special staining for identification (ie, Fontana-Masson, Melan-A, S-100). 4 Development of pigmented SCC is thought to be secondary to increased expression of stem cell factor, possibly secondary to production of promelanocytic factors by tumor cells. 5 External pigment deposition – Incorrect.…”

mentioning

confidence: 99%

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Two discrete bands of longitudinal melanonychia on one fingernail

et al. 2020

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Section: Bmentioning

confidence: 82%

mentioning

confidence: 99%

Two discrete bands of longitudinal melanonychia on one fingernail

et al. 2020

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“…Late presentation could be a potential contributing factor for the delay in diagnosis. Variation in width, longitudinal band with either triangular or pyramidal shape, pigment heterogeneity, Hutchinson’s sign, symptoms such as pain, bleeding, and persistent secondary infection can be features associated with suspected subungual melanoma [ 9 ]…”

Section: Discussionmentioning

confidence: 99%

Chemotherapy-related striate melanonychia: a case report

2021

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Background Chemotherapy medications are reported to cause discoloration of the nails known as melanonychia. Depending on the nail structure affected and the severity of the insult, the clinical features can be variable. There are a great deal of unreported cases of pigmentary nail changes associated with chemotherapy treatment. By sharing our knowledge, we hope to raise the awareness of these nail changes amongst clinicians. Early recognition is crucial to allay anxiety among patients and avoid any unnecessary investigations. Case presentation We present a case of 36-year-old woman of south Asian origin, who developed dark pigmentation in the left thumb nail during neoadjuvant chemotherapy with 5-fluorouracil, epirubicin, cyclophosphamide, and docetaxel (FEC-D) for triple negative breast cancer. Upon examination, the left thumb nail pigmentation was strikingly linear, uniform, and well demarcated extending from proximal nail fold to free margin. Despite the reassuring clinical features, the patient was understandably anxious that this could be a presentation of acral melanoma and was referred to the plastic surgeons for a nail matrix biopsy. Biopsy reassuringly was reported as melanosis and a diagnosis of striate melanonychia was made. The patient was discharged after 2-year follow-up. Conclusion Chemotherapy medications have improved survival rates and patient outcomes. It is important for clinicians to be aware of the association of melanonychia with certain chemotherapy medications to reduce anxiety and allow successful management of these patients without delay. Striate melanonychia in this patient was felt most likely due to the synergistic effect of chemotherapy drugs compounded with racial predisposition. Chemotherapy agents most likely to have contributed include cyclophosphamide, docetaxel, and 5-fluorouracil.

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“…Two main mechanisms are involved in the appearance of melanonychia, melanocytic activation and melanocytic hyperplasia. 2 The distinction between the two can be made based on the medical history of the patient, the clinical picture, dermoscopy and histopathological examination and is essential for the adequate management of the patient. 2…”

Section: Pathogenesismentioning

confidence: 99%

“…2 The distinction between the two can be made based on the medical history of the patient, the clinical picture, dermoscopy and histopathological examination and is essential for the adequate management of the patient. 2…”

Section: Pathogenesismentioning

confidence: 99%

Basic approach to melanonychia: a review

Aseri

Kumawat²,

Tamta³

et al. 2022

Int J Res Dermatol

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Melanonychia is a brownish-black staining of the nail plate. It can affect a single or several nails on both the fingers and toes. Melanocytic activation and melanocytic hyperplasia are the two basic mechanisms involved in the development of melanonychia. Melanocytic activation occurs as enhanced melanic pigmentation of the nail matrix epithelium and nail plate without a corresponding rise in the number of melanocytes, resulting in melanonychia. The number of matrix melanocytes increases in melanocytic hyperplasia. Involvement of a pathogen has also been suggested as a mechanism for its development. A thorough clinical history should be taken, including questions regarding various triggers and causal events, as well as the use of a questionnaire. A proper detailed physical examination is of a great need to properly identify the type of melanonychia and to rule out melanoma which is of great importance in clinical practice. Onychoscopy and nail biopsy also acts as an aid in proper diagnosis of melanonychia. Treatment of melanonychia basically depends on the underlying etiology. One major aim is to rule out melanoma if present and its proper management in time.

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Melanonychia – Clues for a Correct Diagnosis

Cited by 9 publications

References 17 publications

Two discrete bands of longitudinal melanonychia on one fingernail

Two discrete bands of longitudinal melanonychia on one fingernail

Chemotherapy-related striate melanonychia: a case report

Basic approach to melanonychia: a review

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