Subungual Malignant Melanoma: Difficulty in Diagnosis

Leppard, Barbara; Sanderson, K.V.; Behan, Felix

doi:10.1136/bmj.1.5903.310

Cited by 56 publications

(26 citation statements)

References 4 publications

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“…It has no gender predilection, unlike other types of malignant melanoma, which are more common in women. Clinical manifestations include ingrown nail, simple split nail, junctional nevus, chronic paronychia with or without pain, and subungual pigmentation (Fig 12a) (45). However, subungual melanoma is often amelanotic, which results in a delayed diagnosis.…”

Section: Malignant Melanomamentioning

confidence: 98%

Subungual Tumors: Clinicopathologic Correlation with US and MR Imaging Findings

Baek

Lee²,

Cho³

et al. 2010

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Various types of tumors can affect the subungual space, including benign solid tumors (glomus tumor, subungual exostosis, soft-tissue chondroma, keratoacanthoma, hemangioma, lobular capillary hemangioma), benign cystic lesions (epidermal and mucoid cysts), and malignant tumors (squamous cell carcinoma, malignant melanoma). Imaging plays an important role in the detection and differentiation of subungual tumors because of their small size, nonspecific clinical manifestations, and functional significance. Ultrasonography (US)-in particular, high-resolution US with color Doppler studies-provides useful information regarding tumor size, location, shape, and internal characteristics (cystic, solid, or mixed), but it is limited in the further characterization of tissue. Magnetic resonance (MR) imaging has an important role in categorizing tumors according to their anatomic location, pathologic origin, and signal characteristics. There is some overlap between the US and MR imaging features of subungual tumors; however, certain features can allow accurate diagnosis and expedite management when correlated with clinical and pathologic findings.

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Section: Malignant Melanomamentioning

confidence: 98%

Subungual Tumors: Clinicopathologic Correlation with US and MR Imaging Findings

Baek

Lee²,

Cho³

et al. 2010

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170

176

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“…7 he reason for this is that these lesions are rather advanced when first seen (Pack & Oropez, 1967, Leppard et al 1974, Patterson & Helwig 1980. Subungual melanoma is frequently treated as an infection while plantar and palmar melanomas are concealed to a certain extent by the thick horny layer of the epidermis.…”

Section: Nature Of a Lmmentioning

confidence: 99%

The nature of melanoma. A critical review

McGovern

1982

J Cutan Pathol

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The main object of this review was to examine the various histogenetic types of melanoma in order to determine their nature. Nodular melanoma and superficial spreading melanoma differ in the more rapid growth of the former. For tumors of equal depth of invasion in patients of the same sex, the prognoses are similar. Clinical features with prognostic significance are sex, age, and site of the lesion. Women have a decided superiority in survival up to the age of about 50 years when their superiority declines. Survival rates for men also decline after the age of 50 years but to a lesser degree. Melanomas of the extremities have a better prognosis than melanomas of the axial regions. The histological feature of most prognostic significance is depth of invasion (thickness). Ulceration is partly bound to thickness of the lesion, but has an augmentative effect of its own which is related to rate of growth. Thin lesions with or without regression are often associated with meta‐stases. Melanomas arising in Hutchinson's melanotic freckle have a better prognosis than nodular or superficial spreading melanoma but there has not been any series large enough for definitive markers with prognostic significance lo be determined. A similar state pertains in palmar, plantar and subungual melanomas. The initial surgical approach in nodular and superficial melanoma should be based upon the thickness of the tumour, site of the tumour, and sex of the patient. The current classification of malignant melanoma is unsatisfactory. Melanoma arising in Hutchinson's melanotic freckle seems to be a distinct entity. Melanomas of other histogenetic types would be best classified according to site.

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“…This latter practice can sometimes be the source of disastrous consequences because, occasionally, IT can masquerade a serious underlying condition. [6][7][8] Probably under the premise of the expected nonspecificity of the morphologic features of IT, few references can be found in literature regarding its histopathology and none of them have been correlated to the clinical stages of the disease to the best of our knowledge.…”

Section: Discussionmentioning

confidence: 97%

Ingrown Toenail: Histopathologic and Immunohistochemical Study

Fernández-Flores

Nova²,

Salgado-Fernandez³

2009

The American Journal of Dermatopathology

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Although ingrown toenail (IT) is a common problem, the morphologic alterations presented in this condition have rarely been presented in literature. We have studied 14 cases from 12 different patients and studied the biopsies of all of them, not only with routine techniques but also with histochemical stains (Masson trichrome, periodic acid-Schiff, and Gram) and with immunohistochemical techniques mindbomb homolog-1 (MIB-1), p63, D2-40, and AE1-AE3). The patients were clinically classified into 4 stages (1, 2a, 2b, and 3). The main changes evidenced were ingrowing of the squamous epithelium (either from the matrix or mostly from the hyponichium) and chronic plasma-cell rich inflammation with prominent vascularization. The intensity of these changes varied depending on the stage: whereas they were mild in stages 1 and 2a, they were prominent in stages 2b and 3. In advanced stages, the epithelial nests showed certain dyskeratosis. The expression of MIB-1 was, nevertheless, only basal and parabasal. p63 was intensively expressed by the epithelial nests. We therefore conclude that (a) IT shows epithelial ingrowing with accompanying granulation tissue; (b) according to the clinical stage of the disease, this pattern can be more or less complex; (c) in advanced stages of IT, the pattern can mimic a well-differentiated squamous cell carcinoma; (d) MIB-1 is not helpful in distinguishing IT from squamous cell carcinoma; (e) the high expression of p63 by the ingrowing epithelium should not be the source of a misdiagnosis of malignancy.

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Subungual Malignant Melanoma: Difficulty in Diagnosis

Cited by 56 publications

References 4 publications

Subungual Tumors: Clinicopathologic Correlation with US and MR Imaging Findings

Subungual Tumors: Clinicopathologic Correlation with US and MR Imaging Findings

The nature of melanoma. A critical review

Ingrown Toenail: Histopathologic and Immunohistochemical Study

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