Reassessing Melanonychia Striata in Phototypes IV, V, and VI Patients

Astur, Máira de Magalhães Mariano; Farkas, Caroline Benevides; Junqueira, João Paulo; Enokihara, Mílvia Maria Simões e Silva; Enokihara, Mauro Yoshiaki; Michalany, Nílceo Schwery; Hirata, Sérgio Henrique

doi:10.1097/dss.0000000000000639

Cited by 19 publications

(9 citation statements)

References 23 publications

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“…Our findings differ from Hispanic studies (70%) (Astur et al, 2016, Dominguez-Cherit et al, 2008, Molina and Sanchez, 1995), and this may reflect that racial melanonychia is especially common in Hispanic and African-American populations.…”

Section: Discussioncontrasting

confidence: 99%

Longitudinal melanonychia in an Iranian population: a study of 96 patients

Kamyab

Abdollahi

Nezam-Eslami

et al. 2016

International Journal of Women's Dermatology

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BackgroundLongitudinal melanonychia (LM) can be a challenging sign since it may be caused by a wide variety of benign and malignant conditions. Cutaneous melanoma is the most important cause of LM. Objective: We performed this study to examine different aspects of LM in Iran, where cutaneous melanoma is rare.MethodsIn this cross-sectional study, we reviewed medical records and pathology reports of a total of 96 patients presenting with LM. These patients had been visited and undergone nail biopsy in Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran. Demographic, clinical, and pathological data were recorded.ResultsThe most common diagnosis was junctional nevi in 28 patients (29.2%) followed by melanoma in 19 patients (19.8%). Patients had a mean age of 42.4 years (± 19.4). The mean ages in the groups with junctional nevi and melanoma were 33.3 (± 19.5) and 51.9 (± 17.8), respectively; their difference was statistically significant (P value = 0.001). Hutchinson’s sign was present in 10 patients, 9 of which had melanoma. Also, melanoma was only observed in patients presenting with a solitary nail lesion. Nails mostly affected by melanoma were middle fingers of the hands (7 patients) and thumbs (6 patients). Out of 18 patients with nail dystrophy, 13 (72.2%) were diagnosed with melanoma.LimitationsOnly patients who have undergone biopsy were studied.ConclusionMelanoma is an important cause of LM in Iranian patients and should especially be suspected in older patients who present with a solitary nail lesion on their middle finger or thumb. Other findings that direct us toward melanoma are presence of Hutchinson’s sign and nail dystrophy.

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Section: Discussioncontrasting

confidence: 99%

Longitudinal melanonychia in an Iranian population: a study of 96 patients

Kamyab

Abdollahi

Nezam-Eslami

et al. 2016

International Journal of Women's Dermatology

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“…In addition, similar percentages of females (9.7%) and males (11.3%) reported LM. This is consistent with another study showing equal prevalence of LM among males and females [16]. …”

Section: Discussionsupporting

confidence: 82%

“…The prevalence of LM amongst African-American subjects in our study was 17.9%, 11.9% amongst Asian-Americans, 8.5% amongst Latin Americans, and 7.9% amongst Caucasians. In another study, 73% of the patients with skin phototypes IV, V, and VI had LM on physical examination [16]. It is frequently seen in the African-American population, with an estimated 100% of the black patients over 50 years of age having melanonychia [17].…”

Section: Discussionmentioning

confidence: 99%

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

Halteh¹,

Scher²,

Artis³

et al. 2016

Skin Appendage Disord

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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.

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“…Melanonychia striata is noted more often in dark‐skinned individuals (Fitzpatrick phototypes IV, V, and VI) and is rare in white‐skinned individuals . In the pediatric age group, melanonychia striata is not common, even in dark‐skinned individuals . Nevertheless, Skornšek et al .…”

Section: Epidemiologymentioning

confidence: 99%

“…Melanonychia striata, also known as longitudinal melanonychia, is characterized by a tan, brown, or black longitudinal streak within the nail plate that runs from the proximal nail fold to the distal part of the nail plate . Such streaks are commonly seen in dark‐skinned individuals …”

Section: Introductionmentioning

confidence: 99%

Melanonychia striata: clarifying behind the Black Curtain. A review on clinical evaluation and management of the 21st century

et al. 2019

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Melanonychia striata is characterized by a tan, brown, or black longitudinal streak within the nail plate that runs from the proximal nail fold to the distal part of the nail plate.Melanonychia striata is due to increased activity of melanocytes or melanocytic hyperplasia in the nail matrix with subsequently increased melanin deposition in the nail plate. The most common cause of melanonychia striata associated with melanocytic activation is ethnic melanonychia which occurs in dark-skinned individuals. Other causes of melanonychia striata related to melanocytic activation include pregnancy, chronic local trauma, infections, medications, dermatological disorders, endocrine disorders, alkaptonuria, hemochromatosis, porphyria, graft-vs-host disease, Peutz-Jeghers syndrome, and Laugier-Hunziker syndrome. Causes of melanonychia striata associated with melanocytic hyperplasia include nail matrix melanocytic nevus, nail lentigo, and nail apparatus/subungual in situ and invasive melanoma. In most cases, melanonychia striata is a benign condition, especially in children. Consequently, most investigators advocate a wait-and-see approach. Nail apparatus/subungual melanoma should be suspected if there is an abrupt onset after middle age, personal or family history of melanoma, rapid growth, darkening of a melanonychia band, pigment variegation, blurry lateral borders, irregular elevation of the surface, a bandwidth >3 mm, proximal widening, associated nail plate dystrophy, single rather than multiple digit involvement, and periungual spread of pigmentation onto the adjacent cuticle and/or proximal and/or lateral nail folds (Hutchinson sign). Prolonged follow-up is mandatory for early detection of possible malignant changes.

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Reassessing Melanonychia Striata in Phototypes IV, V, and VI Patients

Abstract: Racial melanonychia in skin Types IV, V, or VI patients, resulting from hypermelanosis, may present brown or black coloration of the background in the dermatoscopic examination.

Cited by 19 publications

References 23 publications

Longitudinal melanonychia in an Iranian population: a study of 96 patients

Longitudinal melanonychia in an Iranian population: a study of 96 patients

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

Melanonychia striata: clarifying behind the Black Curtain. A review on clinical evaluation and management of the 21st century

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