Non‐melanoma Hutchinson's sign: a reappraisal of this important, remarkable melanoma simulant

Baran, L; Ruben, Beth S.; Kechijian, Paul; Thomas, Luc

doi:10.1111/jdv.14715

Cited by 25 publications

(18 citation statements)

References 41 publications

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“…The extension of nail bed or nail matrix pigmentation into the proximal nail fold is known as Hutchinson's sign and has been classically associated with radial extension of a subungual melanoma. Although rare, there are other entities with Hutchinson's sign not associated with melanoma such as congenital NMNs, benign tumors, or exogenous pigmentation [1,2]. Our patient presented a subtle longitudinal homogeneous melanonychia, with benign dermoscopic pattern, but also, an intense irregular pigmentation of the eponychium (Hutchinson's sign) with parallel linear brown pigmentation, resembling a brushstroke, some with pseudopod-like figures, on dermoscopy.…”

Section: Discussionmentioning

confidence: 64%

Short Brown Parallel Lines on the Proximal Nail Fold. Clinical-Dermoscopic-Histologic Correlation of a Melanocytic Nevus of the Eponychium

Algarra-Sahuquillo

Ramos‐Rodríguez

Caldeira-Marques

et al. 2023

Skin Appendage Disord

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Introduction: Although Hutchinson’s sign can appear associated with benign conditions, dermoscopic findings of non-melanoma eponychium pigmentation have not yet been described in the literature. We report for the first time to our knowledge the dermoscopic findings of an acral nevus located in the proximal nail fold as well as its clinical-dermoscopic-histologic correlation. Case Report: A twenty-year-old patient presented with a homogeneous longitudinal melanonychia on the left-hand thumb, with benign dermoscopic pattern, and an irregular, 6-mm, dark-brown hyperpigmented macule on the adjacent eponychium (Hutchinson’s sign). The eponychium lesion showed on dermoscopy two irregular brown-black pigmented blotches, with superimposed parallel brown lines on a brushy distribution, with a thicker terminal end. The histopathologic examination of the proximal nail fold was performed, revealing scattered nevus cells in the epidermal basal layer and dermal-epidermal junction thecae, without any atypia or mitosis. These features were consistent with nevus of the proximal nail fold. Discussion: Previous descriptions of benign hyponychium’s pigmentations, despite the malignant appearance of the overlying melanonychia, were reported to have a similar dermoscopic pattern, known as longitudinal brushy pigmentation. This newly described dermoscopic sign on the eponychium may help distinguish Hutchinson’s sign related to subungual melanoma to non-melanoma Hutchinson’s sign.

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Section: Discussionmentioning

confidence: 64%

Short Brown Parallel Lines on the Proximal Nail Fold. Clinical-Dermoscopic-Histologic Correlation of a Melanocytic Nevus of the Eponychium

Algarra-Sahuquillo

Ramos‐Rodríguez

Caldeira-Marques

et al. 2023

Skin Appendage Disord

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“…Hutchinson's sign is the extension of brown and black pigmentation from the nail matrix and nail bed to the proximal and lateral nail folds, or hyponychium, an alarming sign of NM 22–25 . Albeit rare, nail matrix nevi, trauma, drugs, systemic conditions such as Laugier–Hunziker and Peutz‐Jegher syndromes, and connective tissue diseases may give rise to periungual pigmentation 14,26 . Approximately 6–36% of NM are amelanotic, 27–31 which can lead to an increase in diagnostic uncertainty.…”

Section: Diagnosismentioning

confidence: 99%

“…[22][23][24][25] Albeit rare, nail matrix nevi, trauma, drugs, systemic conditions such as Laugier-Hunziker and Peutz-Jegher syndromes, and connective tissue diseases may give rise to periungual pigmentation. 14,26 Approximately 6-36% of NM are amelanotic, [27][28][29][30][31] which can lead to an increase in diagnostic uncertainty. They can be confused with other non-pigmented nail disorders such as onychomycosis, warts, and pyogenic granulomas.…”

Section: Clinical Findingsmentioning

confidence: 99%

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

Darmawan

Ohn

Mun

et al. 2022

Acad Dermatol Venereol

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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.

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“…4 Pigmentation visible through the translucent cuticle like our patient was revealed to be pseudo-Hutchinson's sign. 5 While Hutchinson's sign is common in melanoma, localized hyperkeratosis, dark dots, free edge nail pitting, and hairpin-like vessels are observed more frequently in nail squamous cell carcinoma than in onychomatricoma. 6,7 Our case also resembled subungual Bowen's disease which was frequently associated with high-risk HPV infection.…”

Section: O R R E S P O N D E N C E Onychomatricoma Mimicking Subungual Melanoma and Bowen's Diseasementioning

confidence: 99%

Onychomatricoma mimicking subungual melanoma and Bowen’s disease

Kuriyama

Shimizu

Tamura

et al. 2021

J Cutaneous Imm & Allergy

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Non‐melanoma Hutchinson's sign: a reappraisal of this important, remarkable melanoma simulant

Abstract: The mere presence of periungual pigmentation is neither clinically nor histologically pathognomonic of subungual melanoma and justifies the usefulness of this work stressing the non-melanoma HS.

Cited by 25 publications

References 41 publications

Short Brown Parallel Lines on the Proximal Nail Fold. Clinical-Dermoscopic-Histologic Correlation of a Melanocytic Nevus of the Eponychium

Short Brown Parallel Lines on the Proximal Nail Fold. Clinical-Dermoscopic-Histologic Correlation of a Melanocytic Nevus of the Eponychium

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

Onychomatricoma mimicking subungual melanoma and Bowen’s disease

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