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Alchorne MMDA, Conceição KDC, Barraza LL, Milanez Morgado de Abreu MA. Dermatology in black skin. An Bras Dermatol 2024; 99:327-341. [PMID: 38310012 DOI: 10.1016/j.abd.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 09/25/2023] [Accepted: 10/17/2023] [Indexed: 02/05/2024] Open
Abstract
The vast majority of publications in dermatology refer to lightly pigmented skin, with few addressing the peculiarities of black skin. In addition there is no consensus on what it means to be black in different regions of the world. The lack of knowledge on the subject makes it difficult to recognize and manage dermatoses in this type of skin. This article aims to review the literature on intrinsic characteristics, as well as epidemiological and clinical aspects of the cutaneous manifestations of different dermatoses in black skin. It was found that there are sometimes striking differences, in the structural, biological, and functional aspects when comparing lightly pigmented and black skin. There are also physiological changes that need to be recognized to avoid unnecessary interventions. Some dermatoses have a higher incidence in black skin, such as acne, eczema, dyschromia and dermatophytosis. On the other hand, several dermatoses are more specific to black skin, such as pseudofolliculitis barbae, keloid, dermatosis papulosa nigra, ulcers caused by sickle-cell anemia, dactylolysis spontanea, confluent and reticulated papillomatosis of Gougerot and Carteaud, and some diseases of the hair and scalp (including fragile and brittle hair, traction alopecia, folliculitis keloidalis nuchae, folliculitis dissecans and central centrifugal cicatricial alopecia). A spectrum of peculiar aspects of specific dermatoses, including sarcoidosis, lichen planus (with emphasis on the pigmentosus variant), psoriasis, lupus erythematosus, vitiligo, syphilis, pityriasis versicolor, and neoplasms are highlighted. In the latter, characteristics of basal cell carcinoma, squamous cell carcinoma, and melanoma are compared, in addition to highlighting unusual aspects of primary cutaneous T-cell lymphoma, endemic Kaposi sarcoma, and dermatofibrosarcoma protuberans.
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Affiliation(s)
| | | | - Leonardo Lora Barraza
- Department of Dermatology, Santa Casa de Misericórdia do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Ani O, Xu W, Chang B, Lin IC. Clinical and Histopathological Investigation of Pediatric Melanonychia: A Single-Center Retrospective Case Series. Ann Plast Surg 2024; 92:S87-S90. [PMID: 38556653 DOI: 10.1097/sap.0000000000003865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
HYPOTHESIS The natural history of pediatric melanonychia and the necessity of biopsy for ruling out melanoma are debated in the literature. We hypothesize that there is a low rate of malignant nail pathology among pediatric patients undergoing nail bed biopsy for melanonychia. METHODS We performed a retrospective chart review of 54 pediatric patients (age <18 years) at a single institution who presented with melanonychia and underwent nail bed biopsy from 2007 to 2022. Data points collected included patient demographics, medical history, physical exam findings, pathology reports, and clinical photos. Univariate and multivariate analyses were performed to assess for risk factors associated with high-risk pathology findings. RESULTS The average age of melanonychia onset was 5.5 years (SD 4.4). The average age of first biopsy was 7.8 years (SD 4.3). On physical exam, 27 patients had at least four features concerning for melanoma (asymmetry, border irregularity, color heterogeneity, diameter > 1/3 of nail, evolving color, evolving diameter, Hutchinson's sign). The most common pathology diagnoses were melanocytic nevus (35%), atypical intraepidermal melanocytic proliferation (AIMP) with benign features (24%), subungual lentigo (22%), and AIMP with concerning features (17%). There were no cases of melanoma in situ or invasive malignant melanoma. On multivariate regression, the only significant risk factor associated with more concerning pathology (AIMP with concerning features) was the calendar year in which biopsy was performed (coefficient = -0.34, P = 0.016). There was no association between physical exam features and high-risk pathology. Twelve patients had surgical re-excision of the lesion, 6 of which were due to incomplete excision of AIMP with concerning features and 6 of which were due to recurrence. CONCLUSIONS Our case series did not find any cases of melanoma in situ or malignant melanoma arising from pediatric melanonychia. Atypical intraepidermal melanocytic proliferation with concerning features was associated only with the year in which the biopsy was performed, which may reflect the improved understanding of pediatric melanonychia as often benign despite concerning features on pathology. The decision to perform a nail matrix biopsy in pediatric melanonychia should be based on a collaborative discussion between the patient's parents, dermatologist, and plastic surgeon.
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Affiliation(s)
- Omar Ani
- From the Perelman School of Medicine at the University of Pennsylvania
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3
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Tsai SYC, Hamilton CE, Mologousis MA, Hawryluk EB. Melanoma-like features in pediatric longitudinal melanonychia: A systematic review and meta-analysis. Pediatr Dermatol 2024. [PMID: 38500311 DOI: 10.1111/pde.15597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 02/27/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND Pediatric longitudinal melanonychia (LM) can exhibit atypical features that mimic red-flag signs for subungual melanoma in adults and lead to diagnostic uncertainty. Nail biopsy may be unnecessary if clinical inspection and dermoscopy suggest a benign nature. METHODS We searched PubMed and Embase from inception to February 2023 for studies of any design reporting either the number or proportion of clinical and dermoscopic features in at least five children (≤18 years) with LM. Non-English articles, reviews, and abstracts were excluded. We performed a systematic review and meta-analysis to collate all existing data. RESULTS A total of 1218 articles were screened and 24 studies with 1391 pediatric patients were included. Nevus was the most common diagnosis (86.3%). The most prevalent sites were fingernails (76.2%) and first digits (45.4%). Pooled proportions of common features were: dark-color bands (69.8%), multi-colored bands (47.6%), broad bandwidth (41.1%), pseudo-Hutchinson sign (41.0%), irregular patterns (38.1%), Hutchinson sign (23.7%), dots and globules (22.5%), nail dystrophy (18.2%), and triangular sign (10.9%). Outcomes included progression (widening or darkening, 29.9%), stability (23.3%), and spontaneous regression (narrowing or fading, 19.9%). Only eight cases of subungual melanoma in situ were reported, and no invasive melanomas were identified. CONCLUSION Although atypical characteristics are common in pediatric LM, the probability of malignant transformation is exceedingly low. Appropriate evaluation and management of pediatric LM includes careful clinical and dermoscopic inspection with attention to benign features followed by long-term interval follow-up.
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Affiliation(s)
- Serena Yun-Chen Tsai
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Claire E Hamilton
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Mia A Mologousis
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Elena B Hawryluk
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Lallas A, Korecka K, Apalla Z, Sgouros D, Liopyris K, Argenziano G, Thomas L. Seven Plus One Steps to Assess Pigmented Nail Bands (Melanonychia Striata Longitudinalis). Dermatol Pract Concept 2023; 13:dpc.1304a204. [PMID: 37992383 PMCID: PMC10656147 DOI: 10.5826/dpc.1304a204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2023] [Indexed: 11/24/2023] Open
Abstract
Melanonychia striata longitudinalis might involve one or more fingers and/or toes and might result from several different causes, including benign and malignant tumors, trauma, infections, and activation of melanocytes that might be reactive or related to the pigmentary trait, drugs and some rare syndromes. This broad differential diagnosis renders the clinical assessment of melanonychia striata particularly challenging. Nail matrix melanoma is relatively rare, occurs almost always in adults involves more frequently the first toe or thumb. The most common nail unit cancer, squamous cell carcinoma / Bowen disease (SCC) of the nail matrix is seldom pigmented. Histopathologic examination remains the gold standard for melanoma and SCC diagnosis, but excisional or partial biopsies from the nail matrix require training and is not routinely performed by the majority of clinicians. Furthermore, the histopathologic evaluation of melanocytic lesions of the nail matrix is particularly challenging, since early melanoma has only bland histopathologic alterations. Dermatoscopy of the nail plate and its free edge significantly improves the clinical diagnosis, since specific patterns have been associated to each one of the causes of melanonychia. Based on knowledge generated and published in the last decades, we propose herein a stepwise diagnostic approach for melanonychia striata longitudinalis: 1) Hemorrhage first 2) Age matters 3) Number of nails matters 4) Free edge matters 5) Brown or gray? 6) Size matters 7) Regular or irregular and, finally, "follow back".
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Affiliation(s)
- Aimilios Lallas
- First Dermatology Department, School of Medicine, Faculty of Health Sciences, Aristotle University, Thessaloniki, Greece
| | - Katarzyna Korecka
- Department of Dermatology, Heliodor Swiecicki Clinical Hospital, University of Medical Sciences, Poznan, Poland
| | - Zoe Apalla
- Second Dermatology Department, School of Medicine, Faculty of Health Sciences, Aristotle University, Thessaloniki, Greece
| | - Dimitrios Sgouros
- Second Department of Dermatology and Venereology, ATTIKON General University Hospital, Medical School, National and Kapodistrian University, Athens, Greece
| | | | - Giuseppe Argenziano
- Dermatology Unit, Department of Mentals and Physical Health and Preventive medicine, University of Campania Luigi Vanvitelli Naples, Napoli, Italy
| | - Luc Thomas
- Service de Dermatologie, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France; Université Claude-Bernard-Lyon Lyon, Lyon, France and Lyons cancer research center UMR INSERM U1052 - CNRS5286 - UCBL1 Lyon France
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5
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Wang RF, Ko D, Friedman BJ, Lim HW, Mohammad TF. Disorders of hyperpigmentation. Part I. Pathogenesis and clinical features of common pigmentary disorders. J Am Acad Dermatol 2023; 88:271-288. [PMID: 35151757 DOI: 10.1016/j.jaad.2022.01.051] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/22/2021] [Accepted: 01/10/2022] [Indexed: 01/17/2023]
Abstract
Disorders of hyperpigmentation are common and, depending on the extent and location of involvement, can affect the quality of life and pose a significant psychologic burden for patients. Given the similarities in presentation of the various causes of hyperpigmentation, it is often difficult to elucidate the etiology of these conditions, which is important to guide management. Furthermore, certain disorders, such as lichen planus pigmentosus and ashy dermatosis, have similar clinical and/or histologic presentations, and their classification as distinct entities has been debated upon, leading to additional confusion. In this review, the authors selected commonly encountered disorders of hyperpigmentation of the skin, subdivided into epidermal, dermal, or mixed epidermal-dermal disorders based on the location of pigment deposition, along with disorders of hyperpigmentation of the mucosa and nails. Melanocytic nevi, genetic disorders, and systemic causes of hyperpigmentation were largely excluded and considered to be outside the scope of this review. We discussed the pathogenesis of hyperpigmentation as well as the clinical and histologic features of these conditions, along with challenges encountered in their diagnosis and classification. The second article in this 2-part continuing medical education series focuses on the medical and procedural treatments of hyperpigmentation.
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Affiliation(s)
- Rebecca F Wang
- From the Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Dayoung Ko
- From the Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Ben J Friedman
- From the Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Henry W Lim
- From the Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Tasneem F Mohammad
- From the Department of Dermatology, Henry Ford Hospital, Detroit, Michigan.
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Abstract
Nail conditions are not only aesthetic concerns, and nail changes may be a clue to an underlying systemic diseases or infection. Without timely treatment, nail diseases can continue to worsen and significantly impair performance of daily activities and reduce quality of life. Examination of the nails is essential at every medical visit, and may uncover important findings. Brittle nail syndrome, onychomycosis, paronychia, nail psoriasis, longitudinal melanonychia, Beau's lines, onychomadesis and retronychia are common nail disorders seen in clinical practice. These conditions stem from infectious, inflammatory, neoplastic and traumatic aetiologies. Though each nail condition presents with its own distinct characteristics, the clinical findings may overlap between different conditions, resulting in misdiagnosis and treatment delays. Patients can present with nail plate changes (e.g. hyperkeratosis, onycholysis, pitting), discolouration, pain and inflammation. The diagnostic work-up of nail disease should include a detailed history and clinical examination of all 20 nail units. Dermoscopy, diagnostic imaging and histopathologic and mycological analyses may be necessary for diagnosis. Nail findings concerning for malignancy should be promptly referred to a dermatologist for evaluation and biopsy. Nail disease management requires a targeted treatment approach. Treatments include topical and/or systemic medications, discontinuation of offending drugs or surgical intervention, depending on the condition. Patient education on proper nail care and techniques to minimize further damage to the affected nails is also important. This article serves to enhance familiarity of the most common nail disorders seen in clinical practice. It will highlight the key clinical manifestations, systematic approaches to diagnosis and treatment options for each nail condition to improve diagnosis and management of nail diseases, as well as patient outcomes.Key messagesNail disease is not only a cosmetic issue, as nail changes can indicate the presence of a serious underlying systemic disease, infection or malignancy.Nail pain and changes associated with NP are physically and emotionally distressing and may contribute to functional impairment and diminished quality of life.LM is a hallmark sign of subungual melanoma and this finding warrants further investigation to rule out malignancy.
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Affiliation(s)
- Debra K Lee
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
| | - Shari R Lipner
- Department of Dermatology, Weill Cornell Medicine New York, NY, USA
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Inamadar A. Cyclophosphamide-induced melanonychia striata. BMJ Case Rep 2022. [DOI: 10.1136/bcr-2022-251441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Morato IB, Gontijo JRV, Tavares GT, Bittencourt FV. Longitudinal melanonychia in childhood: a great challenge. An Bras Dermatol 2022; 97:516-519. [PMID: 35691736 PMCID: PMC9263629 DOI: 10.1016/j.abd.2021.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/07/2021] [Accepted: 02/15/2021] [Indexed: 11/01/2022] Open
Affiliation(s)
- Isabela Boechat Morato
- Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
| | - João Renato Vianna Gontijo
- Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil; Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Glaysson Tassara Tavares
- Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil; Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Flávia Vasques Bittencourt
- Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil; Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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Lee DK, Chang MJ, Desai AD, Lipner SR. Clinical and dermoscopic findings of benign longitudinal melanonychia due to melanocytic activation differ by skin type and predict likelihood of nail matrix biopsy. J Am Acad Dermatol 2022; 87:792-799. [PMID: 35752275 DOI: 10.1016/j.jaad.2022.06.1165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/12/2022] [Accepted: 06/02/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Longitudinal melanonychia (LM) is a common dermatologic finding in clinical practice with a broad differential diagnosis. Melanocytic activation is the most common LM etiology. OBJECTIVE To investigate clinical and dermoscopic differences of benign LM based on Fitzpatrick skin type and in biopsied vs. non-biopsied patients. METHODS A 10-year retrospective cohort of 248 benign LM cases at Weill Cornell Dermatology was identified and analyzed. RESULTS Darker-skinned vs. lighter-skinned patients had higher band width percentage (p=0.0125), lower band brightness (p<0.001), more band changes (p=0.0071), and received more biopsies (p=0.032). Biopsied (n=47) vs. non-biopsied patients (n=201) had less multidigit band involvement (p=0.0008), higher band width percentage (p=0.0213), lower band brightness (p=0.0003), and more band changes (p<0.0001). Darker skin types more often had brown vs. grey coloration on dermoscopy (p=0.0232). Mean band width percentage for all biopsied patients was 30.81% (range: 5.80%-100%). LIMITATIONS Single-center retrospective design. Subungual melanoma and other benign LM etiologies were not analyzed. Only 18.95% of patients received a biopsy. CONCLUSION Darker vs. lighter skin types more often present with darker and wider bands, brown vs. grey coloration on dermoscopy, and receive more biopsies. Multi-institutional studies on LM are needed to determine nail matrix biopsy criteria in different skin types.
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Affiliation(s)
- Debra K Lee
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
| | | | - Amar D Desai
- Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Shari R Lipner
- Department of Dermatology, Weill Cornell Medicine New York, NY, USA.
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Heymann WR. Pediatric longitudinal melanonychia: Delaying the bottom line. J Am Acad Dermatol 2022; 87:296-297. [PMID: 35640799 DOI: 10.1016/j.jaad.2022.05.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 05/23/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Warren R Heymann
- Division of Dermatology, Cooper Medical School of Rowan University, Camden, New Jersey.
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Hobelsberger S, Laske J, Aschoff R, Beissert S. Examination of Subungual Hematomas and Subungual Melanocytic Lesions by Using Optical Coherence Tomography and Dermoscopy. Dermatology 2022; 238:1130-1138. [PMID: 35508112 DOI: 10.1159/000524347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 03/26/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Examination of subungual pigmented lesions is sometimes a diagnostic challenge for clinicians. OBJECTIVES The study was aimed to investigate characteristic patterns in optical coherence tomography (OCT) of subungual hematomas and determine distinctive features that can differentiate them from subungual melanocytic lesions. METHODS VivoSight® (Michelson Diagnostics, Maidstone, UK) was used to examine 71 subungual hematomas and 11 subungual melanocytic lesions in 69 patients (18 female and 51 male patients). RESULTS On OCT, bleeding was related to sharply defined black sickle-shaped (p < 0.001) or globular regions (not significant [ns]) with a hyperreflective margin (0.002), a grey center (0.013), hyperreflective lines in the area (ns) or periphery (p = 0.031), peripheral fading (p = 0.029), and red dots in the area (p = 0.001). In the 1 case of melanoma in situ examined, we found curved vessels with irregular sizes and distribution on the dermis of the nailbed, while subungual hematomas and subungual benign nevi presented as clustered red dots and/or regularly distributed curved vessels. CONCLUSION Our findings indicate that the use of OCT in addition to dermoscopy provides high-resolution optical imaging information for the diagnosis of subungual hematoma and facilitates the differential diagnosis of subungual hematomas and subungual melanocytic lesions.
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Affiliation(s)
- Sarah Hobelsberger
- Department of Dermatology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Jörg Laske
- Department of Dermatology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Roland Aschoff
- Department of Dermatology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Stefan Beissert
- Department of Dermatology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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Ríos-Viñuela E, Manrique-Silva E, Nagore E, Nájera-Botello L, Requena L, Requena C. [Translated article] Subungual Melanocytic Lesions in Pediatric Patients. ACTAS DERMO-SIFILIOGRAFICAS 2022. [DOI: 10.1016/j.ad.2021.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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13
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Ríos-Viñuela E, Manrique-Silva E, Nagore E, Nájera-Botello L, Requena L, Requena C. Subungual Melanocytic Lesions in Pediatric Patients. ACTAS DERMO-SIFILIOGRAFICAS 2022; 113:388-400. [PMID: 35623729 DOI: 10.1016/j.ad.2021.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/05/2021] [Accepted: 10/11/2021] [Indexed: 01/07/2023] Open
Abstract
The study of subungual melanocytic lesions can present challenges because of the clinical and histologic characteristics of the nail unit and the difficulty of performing nail biopsies and processing specimens. These lesions can be even more challenging in children due to differences in clinical and epidemiological profiles between the adult and pediatric populations. Many of the clinical features of subungual melanocytic lesions that would raise alarm in an adult do not have the same implications in children. Consensus is also lacking on when a nail biopsy is needed to rule out malignancy in the pediatric setting. In view of these considerations and the rarity of subungual melanoma in childhood, the recommended approach in most cases is a watch-and-wait strategy. Subungual melanocytic lesions in children may also show atypical histopathologic features that are not necessarily associated with aggressive behavior. Subungual melanoma is very rare in childhood, with just 21 cases described to date. None of the patients developed visceral metastasis or died as a result and the diagnosis was controversial in many of the cases. Considering the above and the significantly higher frequency and particular characteristics of longitudinal melanonychia with a benign etiology in children, subungual melanocytic lesions should be managed differently in this setting than in adults. In most cases, a watch-and-wait approach is the most appropriate strategy.
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Affiliation(s)
- E Ríos-Viñuela
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España.
| | - E Manrique-Silva
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España
| | - E Nagore
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España
| | - L Nájera-Botello
- Servicio de Anatomía Patológica, Hospital Universitario Puerta del Hierro, Madrid, España
| | - L Requena
- Servicio de Dermatología, Fundación Jiménez Díaz, Madrid, España
| | - C Requena
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España
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Sandru F, Petca A, Dumitrascu MC, Petca RC, Carsote M. Peutz-Jeghers syndrome: Skin manifestations and endocrine anomalies (Review). Exp Ther Med 2021; 22:1387. [PMID: 34650635 PMCID: PMC8506952 DOI: 10.3892/etm.2021.10823] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 08/27/2021] [Indexed: 12/11/2022] Open
Abstract
Peutz-Jeghers syndrome (PJS), a rare autosomal dominant serine/threonine kinase 11 (STK11)/ liver kinase B1 (LKB1) gene-related genodermatosis, is characterized by oral hyperpigmentation (OHP); multiple gastro-intestinal mucosal benign hamartomatous polyps causing local bleeding, occlusion, intussusception, post-resection small bowel syndrome, associated increased risk of small intestinal cancer (incidence during the third decade); and 76% cumulative higher risk than the global population of developing non-gastrointestinal tumors (female predominance) including ovarian/testicular neoplasia, pancreatic and gynecologic (breast, uterus, ovarian) cancers. Suggestive PJS-associated OHP requires STK11 genetic testing. Abdominal pain in an OHP patient may be related to PJS-associated polyps. Other features include focal depigmentation followed by hyperpigmentation, and xeroderma pigmentosum-like lesions. The severity of the dermatological findings is correlated with gastrointestinal polyps. The STK11 gene is linked to reserve of primordial follicles, polycystic ovary syndrome, female fertility, and spermatogenesis. PJS is associated with 2 types of ovarian sex-cord stroma tumors (SCSTs): annular tubules (SCTATs) and pure Sertoli cell tumors. SCSTs accounts for 8% of ovarian cancer and SCTATs represents 2% of SCST, which may be associated with the overproduction of progesterone. PJS-SCTAT vs. non-PJS-SCTAT reveals bilateral/multifocal, small tumors with a benign behavior vs. a unique ovarian, large tumor with increased malignant/metastasis risk. Male precocious puberty is due to large cell calcifying Sertoli cell tumors (LCCSCTs). Notably, 30-40% of LCCSCTs are caused by PJS or Carney complex. PJS-LCCSCT is not aggressive, but it may be bilateral/multifocal, with the ultrasound hallmark being micro-calcifications. Testicular, intra-tubular large cell hyalinizing Sertoli cell tumor is the second testicle neoplasia in PJS. The skin and mucosal lesions are useful markers of PJS, assisting with the early identification of hamartomatouspolyps and initiation of serial surveillance of ovarian, or testicular neoplasia.
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Affiliation(s)
- Florica Sandru
- Department of Dermatology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Dermatology, ‘Elias’ Emergency Hospital, 011461 Bucharest, Romania
| | - Aida Petca
- Department of Obstetrics and Gynecology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Obstetrics and Gynecology, ‘Elias’ Emergency Hospital, 022461 Bucharest, Romania
| | - Mihai Cristian Dumitrascu
- Department of Obstetrics and Gynecology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Obstetrics and Gynecology, University Emergency Hospital Bucharest, 050098 Bucharest, Romania
| | - Razvan-Cosmin Petca
- Department of Urology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Urology, ‘Prof. Dr. Theodor Burghele’ Clinical Hospital, 061344 Bucharest, Romania
| | - Mara Carsote
- Department of Endocrinology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Endocrinology, ‘C. I. Parhon’ National Institute of Endocrinology, 011863 Bucharest, Romania
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An Evidence-Based Approach to Pediatric Melanonychia. Dermatol Clin 2021; 40:37-49. [PMID: 34799034 DOI: 10.1016/j.det.2021.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Melanonychia including melanonychia striata in children poses a diagnostic dilemma. Atypical clinical features often raise the possibility of malignancy, and a nail unit biopsy may be recommended. Commensurate with atypical clinical features, the histopathology may also appear alarming. However, accumulating data illustrate that most cases of melanonychia striata are benign and suggest that an alternate approach is often warranted for pediatric patients. Herein, we review the existing data regarding pediatric melanonychia striata and offer an evidence-based approach to its evaluation and management.
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Abstract
Nail pigmentation in children can cause significant anxiety in parents and clinicians. Different pigments of the nails, such as yellow, orange, and green, can all occur; however, this paper will focus on the dark pigments: brown, gray, and black pigmentation of the nails. Many causes of dark coloration of the nails exist; almost all causes in pediatric patients are benign and require no treatment. Melanoma is the one diagnosis that physicians do not want to miss. Fortunately, this is extremely rare in children.
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Affiliation(s)
- Jane Sanders Bellet
- Departments of Dermatology and Pediatrics, Duke University School of Medicine, Durham, NC, USA
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17
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Mitchell KN, Tay YK, Heath CR, Silverberg NB. Review article: Emerging issues in pediatric skin of color, Part 2. Pediatr Dermatol 2021; 38 Suppl 2:30-36. [PMID: 34708446 DOI: 10.1111/pde.14774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Dermatology for pediatric skin of color is the application of dermatology to the genetically diverse and distinctive segment of the pediatric population that includes children of non-White racial and ethnic groups with increased pigmentation including individuals of Asian, Hispanic/LatinX, African, Native American, Pacific Island descent, indigenous people among others with overlap in particular individuals, and mixtures thereof. The discipline of pediatric skin of color can be challenging with difficulty in diagnosis of common conditions due to underlying pigmentation, variations in common hair styling practices, and differences in demographics of cutaneous disease. Whereas some conditions are more common in children of color, other conditions have nuances in clinical appearance and therapeutics with regard to skin color. This article, the second of the series, focuses on inflammatory skin disease nuances, melanocytic disorders, and hypopigmented mycosis fungoides.
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Affiliation(s)
- Krystal N Mitchell
- Department of Dermatology, Icahn School of Medicine at Mt Sinai, New York, NY, USA
| | - Yong Kwang Tay
- Department of Dermatology, Changi General Hospital, Singapore, Singapore
| | - Candrice R Heath
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Nanette B Silverberg
- Department of Dermatology, Icahn School of Medicine at Mt Sinai, New York, NY, USA.,Department of Pediatrics, Icahn School of Medicine at Mt Sinai, New York, NY, USA
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18
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Ren J, Ren M, Kong YY, Lv JJ, Cai X, Kong JC. Clinicopathological diversity and outcome of longitudinal melanonychia in children and adolescents: analysis of 35 cases identified by excision specimens. Histopathology 2021; 77:380-390. [PMID: 32314423 DOI: 10.1111/his.14121] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 04/16/2020] [Indexed: 02/03/2023]
Abstract
AIMS Longitudinal melanonychia in paediatric patients often represents a difficult diagnostic challenge, and studies emphasising its clinical and histopathological features are limited due to its low incidence in childhood. METHODS AND RESULTS We retrospectively analysed 35 paediatric cases identified by excision specimens on their clinicopathological features, and performed fluorescence in-situ hybridisation on 13 available cases. Fingernails (77.1%) were more likely to be affected. Total melanonychia and Hutchinson's sign were observed in 10 (28.6%) and 14 (40.0%) cases, respectively. Nail dystrophy at diagnosis was present in five cases. After complete excision of the lesions, four patients relapsed during follow-up (mean = 38 months). Seventeen cases were diagnosed as lentigines and 18 as naevi, among which 11 cases were categorised as lentigines/naevi with atypical melanocytic hyperplasia. Mild-to-moderate nuclear atypia, confluency of melanocytes, focal pagetoid spread and peri-ungual skin involvement were found in 25.7% (9 of 35), 40.0% (14 of 35), 40.0% (14 of 35) and 40.0% (14 of 35) of cases, respectively. Thirteen cases tested by fluorescence in-situ hybridisation showed no copy number aberration at the probed loci. There was a statistically significant difference in the following features between patients aged less and more than 10 years (P < 0.05): cytomorphology, mild-to-moderate nuclear atypia, confluency of melanocytes, focal pagetoid spread and melanocyte count. CONCLUSIONS Some concerning clinicopathological characteristics, which are signs indicative of melanoma in adults, are not uncommon in paediatric longitudinal melanonychia, especially in patients aged ≤ 10 years. Owing to the extremely low incidence of melanoma in paediatric longitudinal melanonychia, in most circumstances a more conservative clinical management strategy should be adopted.
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Affiliation(s)
- Jing Ren
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Min Ren
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yun-Yi Kong
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jiao-Jie Lv
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xu Cai
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jin-Cheng Kong
- Department of Pathology, First People's Hospital, Shanghai Jiaotong University, Shanghai, China
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19
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Ríos-Viñuela E, Nájera-Botello L, Requena L, Nagore E, Requena C. Subungual Melanocytic Lesions: Key Clinical and Pathologic Concepts and Biopsy Techniques. ACTAS DERMO-SIFILIOGRAFICAS 2021; 112:S1578-2190(21)00166-9. [PMID: 34053897 DOI: 10.1016/j.adengl.2021.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 12/26/2020] [Indexed: 11/15/2022] Open
Abstract
Both dermatologists and pathologists sometimes find daunting the evaluation of melanonychia (especially subungual melanocytic lesions) because of the fear of performing nail surgery due to the risk of dystrophy, difficulties processing and interpreting nail biopsy specimens, and a general lack of experience in the field. Nevertheless, mastery of nail biopsy techniques, correct processing and orientation of specimens, and familiarity with the histologic particularities of the nail apparatus can attenuate the undoubted complexity and facilitate the tasks involved. Longitudinal excision is the biopsy technique that ensures the simplest histologic interpretation, and it is associated with a low risk of nail dystrophy when performed correctly. Clinical and epidemiological data are crucial. Subungual melanoma in childhood, for instance, is very rare and even lesions with atypical clinical and/or histologic features are probably benign. The presence of suprabasal melanocytes and other findings that would suggest malignancy at other sites are considered normal in the nail apparatus. Subungual melanoma shows a lentiginous pattern in the early stages of disease, and detection of an inflammatory infiltrate accompanying atypical lentiginous subungual lesions would appear to be one of the first diagnostic findings.
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Affiliation(s)
- E Ríos-Viñuela
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, Spain.
| | - L Nájera-Botello
- Servicio de Anatomía Patológica, Hospital Universitario Puerta del Hierro, Madrid, Spain
| | - L Requena
- Servicio de Dermatología, Fundación Jiménez Díaz, Madrid, Spain
| | - E Nagore
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, Spain
| | - C Requena
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, Spain
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20
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Cohen PR, Shurman J. Fungal Melanonychia as a Solitary Black Linear Vertical Nail Plate Streak: Case Report and Literature Review of Candida-Associated Longitudinal Melanonychia Striata. Cureus 2021; 13:e14248. [PMID: 33959438 PMCID: PMC8093122 DOI: 10.7759/cureus.14248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Longitudinal melanonychia striata, presenting as a black linear vertical band of the nail plate, can be caused by pigmented lesions and non-pigmented etiologies. A fungal infection of the nail plate, also referred to as onychomycosis or tinea unguim, can result from dermatophytes, non-dermatophyte molds, and Candida. Albeit rare, Candida-associated fungal melanonychia can present as a longitudinal black nail plate streak. The case of a 79-year-old man who developed a solitary linear black streak on his right fourth fingernail after a prior history of recent trauma to the digit’s nail folds is described; the fungal culture grew Candida parapsilosis. Including our patient, Candida-associated longitudinal melanonychia striata has been described in four women and two men ranging in age from 40 to 79 years (median, 70 years) at diagnosis. The black streak, present from one month to one year (median, seven months), affected either a hand digit (five patients) or the great toe (one patient). Fungal organisms were visualized on either a potassium hydroxide preparation (one patient), pathologic evaluation of a nail plate specimen (three patients), or both (one patient). Culture grew Candida parapsilosis (two patients), Candidaspecies (two patients), Candida albicans (one patient), and Candida tropicalis (one patient). All of the patients experienced clinical improvement after treatment. Topical treatment (5% amorolfine hydrochloride nail lacquer for two patients or modified Castellani paint and 1% clotrimazole cream for one man) or oral itraconazole (either as monotherapy for two women or combined with 5% amorolfine hydrochloride nail lacquer for one woman) was successfully used. Although the clinical presentation of fungal melanonychia can mimic subungual melanoma when it appears as a solitary black linear vertical nail plate streak, investigative studies--such as a potassium hydroxide preparation, nail plate pathology, nail matrix biopsy, and/or fungal culture--can be used to establish the diagnosis of Candida-associated longitudinal melanonychia striata and exclude the diagnosis of a pigmented melanocytic tumor.
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Affiliation(s)
- Philip R Cohen
- Dermatology, San Diego Family Dermatology, National City, USA
| | - Joseph Shurman
- Pain Management/Palliative Care, Scripps Memorial Hospital, La Jolla, USA
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21
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Yim SH, Kwon IS, Hong D, Jung KE, Lee Y, Seo YJ, Choi CW. Predictor of Subungual Melanoma against Benign Longitudinal Melanonychia: A Retrospective Cohort Study from Korea. Ann Dermatol 2021; 33:147-153. [PMID: 33935456 PMCID: PMC8082004 DOI: 10.5021/ad.2021.33.2.147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 09/14/2020] [Accepted: 09/21/2020] [Indexed: 11/08/2022] Open
Abstract
Background Longitudinal melanonychia (LM) is a common clinical finding. Most cases of LM are benign, and a wait-and-see approach is preferred in the management of this condition. Nevertheless, it is important for clinicians to distinguish subungual melanoma (SUM) from other benign LMs. Objective To evaluate the demographic and clinicopathologic characteristics of LM in the Korean population and to identify the predictor of SUM against other benign conditions. Methods This was a single-center retrospective cohort study including patients who underwent nail biopsy for LM from January 2000 to May 2019. To identify the predictor of SUM, receiver operating characteristic (ROC) analyses was performed. Results A total of 68 cases of biopsy-proven LM were included in the analysis. Among the 68 cases, 8 were SUM. In univariable analysis, patients diagnosed with SUM were older (p=0.035) and had a longer disease duration (p=0.004). They also showed multicolor pigmentation of LM (p=0.022), a larger width of LM (p<0.001), and associated nail plate dystrophy (p=0.010) than patients diagnosed with benign conditions. In multivariable logistic regression, width of LM showed statistical significance (odds ratio, 1.083; 95% confidence interval, 1.018~1.153). ROC analysis suggested that an LM width >28% of the whole nail was the predictor of SUM (area under the curve=0.883; p<0.001). Conclusion SUM has distinct demographic and clinical features. The width of LM can predict SUM against other benign LMs.
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Affiliation(s)
- Su-Hyuk Yim
- Department of Dermatology, School of Medicine, Chungnam National University, Daejeon, Korea
| | - In Sun Kwon
- Clinical Trials Center, Chungnam National University Hospital, Daejeon, Korea
| | - Dongkyun Hong
- Department of Dermatology, School of Medicine, Chungnam National University, Daejeon, Korea
| | - Kyung Eun Jung
- Department of Dermatology, School of Medicine, Chungnam National University, Daejeon, Korea
| | - Young Lee
- Department of Dermatology, School of Medicine, Chungnam National University, Daejeon, Korea
| | - Young-Joon Seo
- Department of Dermatology, School of Medicine, Chungnam National University, Daejeon, Korea
| | - Chong Won Choi
- Department of Dermatology, School of Medicine, Chungnam National University, Daejeon, Korea
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22
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Ríos-Viñuela E, Nájera-Botello L, Requena L, Nagore E, Requena C. Subungual Melanocytic Lesions: Key Clinical and Pathologic Concepts and Biopsy Techniques. ACTAS DERMO-SIFILIOGRAFICAS 2021; 112:S0001-7310(21)00003-X. [PMID: 33465340 DOI: 10.1016/j.ad.2020.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/11/2020] [Accepted: 12/26/2020] [Indexed: 12/11/2022] Open
Abstract
Both dermatologists and pathologists sometimes find daunting the evaluation of melanonychia (especially subungual melanocytic lesions) because of the fear of performing nail surgery due to the risk of dystrophy, difficulties processing and interpreting nail biopsy specimens, and a general lack of experience in the field. Nevertheless, mastery of nail biopsy techniques, correct processing and orientation of specimens, and familiarity with the histologic particularities of the nail apparatus can attenuate the undoubted complexity and facilitate the tasks involved. Longitudinal excision is the biopsy technique that ensures the simplest histologic interpretation, and it is associated with a low risk of nail dystrophy when performed correctly. Clinical and epidemiological data are crucial. Subungual melanoma in childhood, for instance, is very rare and even lesions with atypical clinical and/or histologic features are probably benign. The presence of suprabasal melanocytes and other findings that would suggest malignancy at other sites are considered normal in the nail apparatus. Subungual melanoma shows a lentiginous pattern in the early stages of disease, and detection of an inflammatory infiltrate accompanying atypical lentiginous subungual lesions would appear to be one of the first diagnostic findings.
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Affiliation(s)
- E Ríos-Viñuela
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España.
| | - L Nájera-Botello
- Servicio de Anatomía Patológica, Hospital Universitario Puerta de Hierro, Madrid, España
| | - L Requena
- Servicio de Dermatología, Fundación Jiménez Díaz, Madrid, España
| | - E Nagore
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España
| | - C Requena
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España
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23
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Ren M, Ren J, Cai X, Shen XX, Kong JC, Dai B, Kong YY. Clinicopathological, immunohistochemical and fluorescence in-situ hybridisation features of early subungual melanoma: an analysis of 65 cases. Histopathology 2020; 78:717-726. [PMID: 33065755 DOI: 10.1111/his.14279] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/12/2020] [Accepted: 10/12/2020] [Indexed: 02/03/2023]
Abstract
AIMS Very limited data are available concerning the clinicopathological and molecular features of early subungual melanoma (SM), especially with regard to the Asian population. The aim of this study was to investigate the clinical, histological, immunohistochemical and chromosomal features of early SM. METHODS AND RESULTS Fifty-two in-situ and 13 thin (Breslow thickness ≤1.0 mm) SM cases were retrospectively reviewed. All patients presented with longitudinal melanonychia involving a single digit, and the thumb was the most affected digit (35 of 65, 53.8%). Microscopically, most cases showed small to medium nuclear enlargement (58 of 65) and mild to moderate nuclear atypia (57 of 65). Hyperchromatism and irregular contours of nuclei were persistent features in all cases. The variation of melanocyte count (the number of melanocytes per mm dermal-epithelial junction) ranged from 31 to 255. Intra-epithelial mitoses were identified in 34 cases (52.3%). Statistically, features of in-situ lesions including higher melanocyte count (>70), presence of multinucleated melanocytes, inflammatory infiltrate and cutaneous adnexal extension, were associated with early invasion. Melan-A, human melanoma B (HMB)45, mouse monoclonal melanoma antibody (PNL2) and SOX10 antibodies (>95.0%) showed superior diagnostic sensitivity to S-100 protein (83.1%). Fluorescence in-situ hybridisation (FISH) results were positive in 15 of 23 successfully analysed cases. CONCLUSIONS To the best of our knowledge, this is the largest single-institution study of early SM in an Asian population, and the largest cohort tested by FISH. Early SM mainly showed small to medium nuclear enlargement and mild to moderate nuclear atypia. High melanocyte count, hyperchromatism and irregular contours of nuclei and intra-epithelial mitoses are crucial diagnostic parameters. Immunohistochemistry, especially SOX10 staining, and FISH analysis are valuable in the diagnosis of SM.
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Affiliation(s)
- Min Ren
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jing Ren
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xu Cai
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xu-Xia Shen
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jin-Cheng Kong
- Department of Pathology, First People's Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Bo Dai
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Yun-Yi Kong
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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24
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Leung AKC, Lam JM, Leong KF, Hon KL, Barankin B, Leung AAM, Wong AHC. Onychomycosis: An Updated Review. ACTA ACUST UNITED AC 2020; 14:32-45. [PMID: 31738146 PMCID: PMC7509699 DOI: 10.2174/1872213x13666191026090713] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 10/16/2019] [Accepted: 10/23/2019] [Indexed: 12/19/2022]
Abstract
Background: Onychomycosis is a common fungal infection of the nail. Objective: The study aimed to provide an update on the evaluation, diagnosis, and treatment of onychomycosis. Methods: A PubMed search was completed in Clinical Queries using the key term “onychomycosis”. The search was conducted in May 2019. The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews published within the past 20 years. The search was restricted to English literature. Patents were searched using the key term “onychomycosis” in www.freepatentsonline.com. Results: Onychomycosis is a fungal infection of the nail unit. Approximately 90% of toenail and 75% of fingernail onychomycosis are caused by dermatophytes, notably Trichophyton mentagrophytes and Trichophyton rubrum. Clinical manifestations include discoloration of the nail, subungual hyperkeratosis, onycholysis, and onychauxis. The diagnosis can be confirmed by direct microscopic examination with a potassium hydroxide wet-mount preparation, histopathologic examination of the trimmed affected nail plate with a periodic-acid-Schiff stain, fungal culture, or polymerase chain reaction assays. Laboratory confirmation of onychomycosis before beginning a treatment regimen should be considered. Currently, oral terbinafine is the treatment of choice, followed by oral itraconazole. In general, topical monotherapy can be considered for mild to moderate onychomycosis and is a therapeutic option when oral antifungal agents are contraindicated or cannot be tolerated. Recent patents related to the management of onychomycosis are also discussed. Conclusion: Oral antifungal therapies are effective, but significant adverse effects limit their use.Although topical antifungal therapies have minimal adverse events, they are less effective than oral antifungal therapies, due to poor nail penetration. Therefore, there is a need for exploring more effective and/or alternative treatment modalities for the treatment of onychomycosis which are safer and more effective.
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Affiliation(s)
- Alexander K C Leung
- Department of Pediatrics, The University of Calgary, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Joseph M Lam
- Department of Pediatrics and Department of Dermatology and Skin Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Kin F Leong
- Pediatric Institute, Kuala Lumpur General Hospital, Kuala Lumpur, Malaysia
| | - Kam L Hon
- Department of Paediatrics, The Chinese University of Hong Kong, and Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Shatin, Hong Kong
| | | | - Amy A M Leung
- Department of Family Medicine, The University of Alberta, Edmonton, Alberta, Canada
| | - Alex H C Wong
- Department of Family Medicine, The University of Calgary, Calgary, Alberta, Canada
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25
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Sputa‐Grzegrzolka P, Wozniak Z, Akutko K, Pytrus T, Baran W, Calik J, Glatzel‐Plucinska N, Domagala Z, Podhorska‐Okolow M, Stawarski A, Dziegiel P. Laugier‐Hunziker syndrome: a case report of the pediatric patient and review of the literature. Int J Dermatol 2020; 59:1513-1519. [DOI: 10.1111/ijd.15262] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/12/2020] [Accepted: 09/23/2020] [Indexed: 02/06/2023]
Affiliation(s)
| | | | - Katarzyna Akutko
- 2nd Department and Clinic of Pediatrics, Gastroenterology and Nutrition Wroclaw Medical University Poland
| | - Tomasz Pytrus
- 2nd Department and Clinic of Pediatrics, Gastroenterology and Nutrition Wroclaw Medical University Poland
| | - Wojciech Baran
- Department of Dermatology, Venereology and Allergology Wroclaw Medical University Poland
| | - Jacek Calik
- Department of ChemotherapyLower Silesian Oncology Center Wroclaw Poland
| | - Natalia Glatzel‐Plucinska
- Division of Histology and Embryology Department of Human Morphology and Embryology Wroclaw Medical University Poland
| | - Zygmunt Domagala
- Division of Anatomy Department of Human Morphology and Embryology Wroclaw Medical University Poland
| | | | - Andrzej Stawarski
- 2nd Department and Clinic of Pediatrics, Gastroenterology and Nutrition Wroclaw Medical University Poland
| | - Piotr Dziegiel
- Division of Histology and Embryology Department of Human Morphology and Embryology Wroclaw Medical University Poland
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26
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Itani Y, Oiso N, Yanagihara S, Okahashi K, Isogai N, Kawada A. Subungual melanoma in situ in a 21-year-old man: How to manage a patient with longitudinal melanonychia from infant? Int J Dermatol 2020; 60:e9-e10. [PMID: 32614068 DOI: 10.1111/ijd.15031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 06/05/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Yoshihito Itani
- Departments of Dermatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan.,Departments of Plastic and Reconstructive Surgery, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Naoki Oiso
- Departments of Dermatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Shigeto Yanagihara
- Departments of Dermatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Kazunori Okahashi
- Departments of Dermatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Noritaka Isogai
- Departments of Plastic and Reconstructive Surgery, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Akira Kawada
- Departments of Dermatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
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27
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Sahin S, Aydingoz I, Ersoy Evans S, Demircioglu Duman D, Di Chiacchio N, Haneke E. Zigzag longitudinal melanonychia: a peculiar dermoscopic pattern. J Eur Acad Dermatol Venereol 2020; 34:1855-1858. [DOI: 10.1111/jdv.16517] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 03/27/2020] [Indexed: 02/03/2023]
Affiliation(s)
- S. Sahin
- Department of Dermatology School of Medicine Acibadem Mehmet Ali Aydinlar University Istanbul Turkey
| | - I.E. Aydingoz
- Department of Dermatology School of Medicine Acibadem Mehmet Ali Aydinlar University Istanbul Turkey
| | - S. Ersoy Evans
- Department of Dermatology Faculty of Medicine Hacettepe University Ankara Turkey
| | - D. Demircioglu Duman
- Department of Dermatology School of Medicine Acibadem Mehmet Ali Aydinlar University Istanbul Turkey
| | - N.G. Di Chiacchio
- Faculdade de Medicina do ABC Sante André Brazil
- Hospital do Servidor Publico Municipal Sao Paulo Brazil
| | - E. Haneke
- Department of Dermatology, Inselspital Bern University Hospital University of Bern Bern Switzerland
- Centro de Dermatologia Epidermis Instituto CUF Porto Portugal
- Dermatology Clinic Dermaticum Freiburg Germany
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28
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Stefanaki C, Soura E, Sgouros D, Leotsakos G, Rigopoulos D, Stratigos A, Kontochrostopoulos G. Nail matrix naevi in children: a prospective study. J Eur Acad Dermatol Venereol 2020; 34:e203-e205. [PMID: 31850539 DOI: 10.1111/jdv.16154] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- C Stefanaki
- Pediatric Dermatology Clinic, Andreas Sygros University Skin Hospital, Athens, Greece
| | - E Soura
- Pediatric Dermatology Clinic, Andreas Sygros University Skin Hospital, Athens, Greece
| | - D Sgouros
- First Dermatology Clinic, Sygros University Skin Hospital, Athens, Greece
| | - G Leotsakos
- Pediatric Dermatology Clinic, Andreas Sygros University Skin Hospital, Athens, Greece
| | - D Rigopoulos
- First Dermatology Clinic, Sygros University Skin Hospital, Athens, Greece
| | - A Stratigos
- First Dermatology Clinic, Sygros University Skin Hospital, Athens, Greece
| | - G Kontochrostopoulos
- Pediatric Dermatology Clinic, Andreas Sygros University Skin Hospital, Athens, Greece
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Laugier–Hunziker Syndrome in an 8-Year-Old Boy with Scleral Melanocytosis, Lingual Pigmentation, Labial Pigmentation, and Melanonychia Striata. Case Rep Pediatr 2020; 2020:8267805. [PMID: 32257493 PMCID: PMC7103058 DOI: 10.1155/2020/8267805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 02/22/2020] [Indexed: 11/17/2022] Open
Abstract
Laugier–Hunziker syndrome is a rare, acquired disorder characterized by mucocutaneous hyperpigmentation and melanonychia striata with no underlying systemic abnormalities. We report an 8-year-old boy with Laugier–Hunziker syndrome who presented with melanonychia striata affecting all the fingernails and toenails, macular pigmentation on the tongue and the lower lip, and scleral melanocytosis. Melanonychia striata rarely affect all the twenty nails, and scleral melanocytosis has rarely been reported in association with Laugier–Hunziker syndrome. Laugier–Hunziker syndrome occurs predominately in adults. Our patient is the youngest reported patient with Laugier–Hunziker syndrome.
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Liu KL, Tsai WC. Picosecond laser as a promising treatment option for longitudinal melanonychia caused by melanocytic activation: Report of two cases. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2019; 36:163-165. [PMID: 31769077 DOI: 10.1111/phpp.12526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 10/24/2019] [Accepted: 11/22/2019] [Indexed: 01/04/2023]
Affiliation(s)
- Kwei-Lan Liu
- Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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