Nail clipping with onychomycosis and surprise clue to the diagnosis of nail unit melanoma

Gatica-Torres, Michelle; Nelson, Caroline A.; Lipoff, Jules B.; Miller, Christopher J.; Rubin, Adam I.

doi:10.1111/cup.13333

Cited by 10 publications

(21 citation statements)

References 16 publications

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“…Another important observation was made in this manuscript, which is the variability of HMB‐45 and Melan‐A staining of the LCRM in the nail plate in both subungual melanoma and nail matrix nevi specimens. Such variability of staining of melanocytic markers of melanocytes in the nail plate in nail clippings has been identified in the past 2,3 . These prior reports have identified S‐100 as a marker that may function better in highlighting melanocytes in the nail plate but, in our hands, even this marker can have variability in staining intensity between stain runs.…”

supporting

confidence: 54%

“…Such variability of staining of melanocytic markers of melanocytes in the nail plate in nail clippings has been identified in the past. 2,3 These prior reports have identified S-100 as a marker that may function better in highlighting melanocytes in the nail plate but, in our hands, even this marker can have variability in staining intensity between stain runs. We have discussed in the past that this variability in staining may be related to softening techniques which are employed to process specimens that include nail plate.…”

mentioning

confidence: 56%

“…2 In part, the problem may stem from how we define PCγδTCL versus mycosis fungoides (MF) with a gamma-delta phenotype (γδMF). 3 As recognized by the World Health Organization (WHO) classification and diagnostic criteria for cutaneous lymphomas, there is ample documentation that MF can present with a γδ phenotype with allegedly no impact…”

mentioning

confidence: 99%

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Evaluation of large cellular remnants of melanocytes in the nail plate: An advancement in the correlation of diagnosis and prognosis for nail unit melanocytic lesions

2022

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confidence: 54%

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confidence: 56%

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Evaluation of large cellular remnants of melanocytes in the nail plate: An advancement in the correlation of diagnosis and prognosis for nail unit melanocytic lesions

2022

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“…However, even in NMN, melanocytes may sometimes be visible within the nail plate. It has been noted that occasional melanocytes in the nail plate can be commonly found particularly in pediatric NMN 5,6,12 . Because our study was a retrospective study, the patients with NMN were unintentionally younger than the patients with SUM.…”

Section: Discussionmentioning

confidence: 89%

Distribution of cellular remnants of melanocytes in the nail plate: Clue to the diagnosis of subungual melanoma

Lee

et al. 2021

J Cutan Pathol

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Background Previous studies reported that cellular remnants in the nail plate could be a diagnostic clue for subungual melanoma (SUM). We sought to characterize the histopathologic features of cellular remnants in the nail plates of SUM patients. Methods A retrospective case‐control study was conducted in a single tertiary center from 2012 to 2019. Twenty‐three patients with pathologically diagnosed SUM and eight nail matrix nevi (NMN) patients were recruited. The analysis of the nail plate specimens focused on large cellular remnants of melanocytes (LCRMs). Longitudinal linear density and vertical distribution pattern of the LCRMs were scrutinized for possible features distinguishing SUM from NMN. Results The median linear density of the LCRMs was significantly higher in the SUM samples than in the NMN samples. LCRMs in the SUM samples were more dorsally distributed than those in the NMN samples. In invasive SUM, LCRMs were more likely to be found in the dorsal part of the nail plate compared to SUM in situ. Conclusion Nail plate specimens should not be overlooked in the histopathological examination of melanonychia. High‐density LCRMs with more dispersion to the dorsal side might be suggestive of SUM.

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“…Nail apparatus melanoma commonly presents with a ≥3 mm-thick brown or black band with variegated borders, nail dystrophy and Hutchinson's sign, where the proximal and/or lateral nail fold is pigmented (41)(42)(43)(44). Nail apparatus melanoma can be mistaken for onychomycosis and they may be co-exist with onychomycosis, thus detailed investigation is warranted in onychomycosis with malignant features (45,46).…”

Section: Nail Apparatus Melanomamentioning

confidence: 99%

Diagnosis of Onychomycosis: From Conventional Techniques and Dermoscopy to Artificial Intelligence

2021

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Onychomycosis is a common fungal nail infection. Accurate diagnosis is critical as onychomycosis is transmissible between humans and impacts patients' quality of life. Combining clinical examination with mycological testing ensures accurate diagnosis. Conventional diagnostic techniques, including potassium hydroxide testing, fungal culture and histopathology of nail clippings, detect fungal species within nails. New diagnostic tools have been developed recently which either improve detection of onychomycosis clinically, including dermoscopy, reflectance confocal microscopy and artificial intelligence, or mycologically, such as molecular assays. Dermoscopy is cost-effective and non-invasive, allowing clinicians to discern microscopic features of onychomycosis and fungal melanonychia. Reflectance confocal microscopy enables clinicians to observe bright filamentous septate hyphae at near histologic resolution by the bedside. Artificial intelligence may prompt patients to seek further assessment for nails that are suspicious for onychomycosis. This review evaluates the current landscape of diagnostic techniques for onychomycosis.

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Nail clipping with onychomycosis and surprise clue to the diagnosis of nail unit melanoma

Cited by 10 publications

References 16 publications

Evaluation of large cellular remnants of melanocytes in the nail plate: An advancement in the correlation of diagnosis and prognosis for nail unit melanocytic lesions

Evaluation of large cellular remnants of melanocytes in the nail plate: An advancement in the correlation of diagnosis and prognosis for nail unit melanocytic lesions

Distribution of cellular remnants of melanocytes in the nail plate: Clue to the diagnosis of subungual melanoma

Diagnosis of Onychomycosis: From Conventional Techniques and Dermoscopy to Artificial Intelligence

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