Nail melanoma: a review of the literature with recommendations to improve patient management

Banfield, Cedric C.; Dawber, R.P.R.

doi:10.1046/j.1365-2133.1999.03099.x

Cited by 64 publications

(50 citation statements)

References 33 publications

(49 reference statements)

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“…Indications of probable benign multiple lesions are phototype V or VI skin or lesions present since childhood. 15 The literature on dermoscopic examination of the nails is limited to very few published observations, [20][21][22][23] in contrast to the large body of information available on dermoscopy of pigmented lesions elsewhere on the skin. [24][25][26][27] The goals of our study were to (1) (2) try to individualize relevant dermoscopic patterns; and (3) evaluate pattern correlation with 6 different etiologic diagnoses (melanoma, nevus, drug-induced nail pigmentation, nail apparatus lentigo, ethnic-type nail pigmentation, and subungual hemorrhages).…”

Section: Discussionmentioning

confidence: 99%

“…2002;138:1327-1333 E ARLY DIAGNOSIS of nail apparatus melanoma in its pigmented form is difficult because several benign conditions share the same clinical features (ie, longitudinal melanonychia). [1][2][3][4][5][6][7][8][9][10][11][12][13][14] Several clinical criteria have been proposed to help clinicians more accurately distinguish suggestive cases, 15 but neither a single clinical criterion nor a combination of symptoms currently can be used to avoid numerous useless painful nail matrix biopsies that may leave dystrophic scars. [16][17][18][19] Longitudinal melanonychia is suggestive when it is unique, polychrome, increasing in width, or accompanied by the Hutchinson sign (pigmentation of the cuticle).…”

Section: Discussionmentioning

confidence: 99%

“…[36][37][38] Some authors recommend systematic biopsy 39 ; others propose histopathologic diagnosis in suggestive cases only. 15 From the clinical point of view, suggestive lesions have their onset during adulthood, are localized on only the nail, range in color from light brown to black, enlarge progressively, and are associated with a pigmentation of the eponychium called Hutchinson sign. [40][41][42][43][44] In contrast, lesions are more likely to be benign if there is a history of inflammatory disease of the nail or pigmentation-inducing drug intake, if similar lesions are found on several nails, if the onset of the lesion was in childhood, [45][46][47] if the pigmentation is regular, and if Hutchinson sign is absent.…”

Section: Commentmentioning

confidence: 99%

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Dermoscopic Examination of Nail Pigmentation

Ronger¹,

Touzet²,

Ligeron³

et al. 2002

Arch Dermatol

285

232

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Background: Diagnosis of longitudinal melanonychia is usually difficult, and neither a single clinical criterion nor a combination of symptoms currently can be used to clearly distinguish malignant from benign bandlike pigmented nail lesions. Biopsy is painful and often leaves definitive dystrophic scars.Objectives: To describe and evaluate dermoscopic patterns associated with longitudinal nail pigmentation.Patients and Methods: A total of 148 unselected consecutive cases of longitudinal melanonychia were included over a period of 4 years (20 melanoma, 37 nevi, 16 druginduced nail pigmentation, 45 nail apparatus lentigo of various types, 8 ethnic-type nail pigmentation, and 22 subungual hemorrhages). All patients were recruited from the dermatology unit outpatient clinic of the Hô tel Dieu de Lyon. All cases were photographed in vivo under oil immersion (dermoscopy). Patterns were recorded prior to final pathologic diagnosis. An independent biostatistics unit performed statistical evaluation using 7 semiologic patterns.Results: Melanoma cases were significantly associated with a brown coloration of the background and the pres-

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Commentmentioning

confidence: 99%

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Dermoscopic Examination of Nail Pigmentation

Ronger¹,

Touzet²,

Ligeron³

et al. 2002

Arch Dermatol

285

232

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“…Periungual pigmentation (Hutchinson's sign) may be present. More advanced cases may show partial or complete nail plate destruction [8]. The presence of multiple shades of brown and black, homogenous black pigmentation, melanonychia with width of 3 mm or more or an irregular or blurred border must raise suspicion for melanoma [9,10].…”

Section: Introductionmentioning

confidence: 99%

Nail Apparatus Melanoma: Experience of 10 Years in a Single Institution

Lee

Arbache

Quaresma

et al. 2018

Skin Appendage Disord

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Background: Nail apparatus melanoma (NAM) is rare. The higher mortality reported in the literature is most likely due to advanced disease associated with delayed diagnosis and treatment. Objective: All patients diagnosed with NAM were followed at a single reference center during a period of 10 years, with emphasis on dermatological and histological findings. Clinical outcomes were included. Methods: A retrospective review of medical records, photographs, and histopathological examination. Results: 73.7% of the patients were female and their mean age was 47 years. Caucasian and African-American patients had a similar incidence (47.4%). There was only 1 Asian patient in this study (5.3%). All patients presented with nail plate pigmentation. The mean prediagnosis duration was 33 months. A total of 63.2% patients had in situ melanoma and an average Breslow index of 2.18 mm in invasive cases. Fifteen patients underwent conservative surgery and 3 underwent phalanx amputation. All patients survived, and 4 have had more than a 5-year follow-up. Conclusion: In situ lesions showed longitudinal bands or total melanonychia with no nail dystrophy. Invasive cases presented with dystrophic lesions (longitudinal splitting of the nail). Conservative surgery provides a good option without worsening the prognosis. All dermatologists should be aware of early signs of NAM, since prognosis depends on early treatment.

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“…In contrast to melanoma in other sites, it has a worse prognosis, with the 5-year survival rate ranges from 16% to 87% [3,4]. Histological diagnosis is frequently delayed due to clinical misdiagnosis.…”

Section: Introductionmentioning

confidence: 99%

A Hidden Threat: Subungual Melanoma in Hand

Tang¹,

Fung²,

Lung³

2012

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Subungual melanoma, a relatively uncommon disease, has a worse prognosis than cutaneous melanoma in other sites. Both this life-threatening disease and its treatment cause cosmetic and functional impairment to the patient. The diagnosis is often delayed and resulting an advanced disease at presentation. The important clinical manifestation, diagnosis and latest treatments for subungual melanoma are reviewed. Electronic databases of Medline, PubMed, and the Cochrane library were searched with the key word "subungual melanoma". A clinical scoring system is proposed by the authors to stratify patients to undergo biopsy, making earlier diagnosis of this disease possible. The latest trend of treatment involves wide local excision at a more distal level of the affected digit, in contrast to radical amputation of the digit in the past. Studies have shown that this does not decrease the survival nor increase local recurrence, but reduces the functional impairment for the patient. This review aims to summarise the approach to subungual melanoma for clinicians, so that they can recognise and diagnose this disease early and generate the best functional and cosmetic outcome for the patients.

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Nail melanoma: a review of the literature with recommendations to improve patient management

Cited by 64 publications

References 33 publications

Dermoscopic Examination of Nail Pigmentation

Dermoscopic Examination of Nail Pigmentation

Nail Apparatus Melanoma: Experience of 10 Years in a Single Institution

A Hidden Threat: Subungual Melanoma in Hand

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