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de Nicolas-Ruanes B, Azcarraga-Llobet C, Jimenez-Cauhe J. Use of bone wax as a nail bed dressing after excision of subungual tumors. J Am Acad Dermatol 2024; 90:e167-e168. [PMID: 38081391 DOI: 10.1016/j.jaad.2023.11.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 11/04/2023] [Accepted: 11/11/2023] [Indexed: 01/03/2024]
Affiliation(s)
| | | | - Juan Jimenez-Cauhe
- Dermatology Department, Ramon y Cajal University Hospital, Madrid, Spain
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2
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Valenzuela CD, Fowler G, Kozuma K, Kusaka S, Vetto JT. Long-term outcomes after amputation and sentinel node biopsy for subungual melanoma: A single-institution series. Am J Surg 2024; 231:79-85. [PMID: 38492992 DOI: 10.1016/j.amjsurg.2024.02.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 01/28/2024] [Accepted: 02/23/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND Subungual melanoma (SUM) is a rare tumor with historically poor outcomes. Thus, the benefit of proximal versus distal amputation in SUM remains unclear. METHODS We performed a retrospective review of our prospectively-maintained institutional melanoma database, including SUM and non-subungual acral melanoma (AM) patients who underwent sentinel lymph node biopsy (SLNB) between 1999 and 2022. All SUMs had distal joint or proximal amputations. Primary endpoints were overall survival (OS) and recurrence free survival (RFS). Kaplan-Meier estimates, and Cox univariate and multivariate analyses were performed. Tests were repeated on propensity score matched (PSM) populations in a 2:1 ratio. RESULTS 123 patients underwent resection with SLNB for SUM (n = 27) and AM (n = 96). Median follow-up was 9.2 years. Unadjusted median OS was 149.1 months for AM and 198.1 months for SUM. In the PSM comparison, median OS and RFS remained comparable between SUM and AM (149.5 months versus 198.1 months; p = 0.612). Sentinel node positivity was associated with significantly worse overall survival outcome (Hazard Ratio 5.49; CI (1.59-18.97), p = 0.007). In the PSM population, male sex was also associated with a significant hazard of death (HR 3.00, CI (1.03-8.71), p = 0.043). Proximal amputations were associated with significantly worse OS (p < 0.002) and RFS (p < 0.01) compared to distal amputations in SUM. CONCLUSION SUM was well-treated with distal amputations, and had better OS and RFS compared to SUM treated with proximal amputations. Sentinel lymph node status is an important prognostic factor for SUMs and AMs. SUMs can be treated similarly to AMs with comparably good long-term outcomes.
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Affiliation(s)
- Cristian D Valenzuela
- Oregon Health & Science University, Department of Surgery, Division of Surgical Oncology, Portland, OR, 97239, USA; OHSU Knight Cancer Institute, Portland, OR, 97239, USA.
| | - Graham Fowler
- Oregon Health & Science University, Department of Surgery, Division of Surgical Oncology, Portland, OR, 97239, USA; OHSU Knight Cancer Institute, Portland, OR, 97239, USA
| | - Kaiya Kozuma
- Oregon Health & Science University, Department of Surgery, Division of Surgical Oncology, Portland, OR, 97239, USA; OHSU Knight Cancer Institute, Portland, OR, 97239, USA
| | - Sonny Kusaka
- Oregon Health & Science University, Department of Surgery, Division of Surgical Oncology, Portland, OR, 97239, USA
| | - John T Vetto
- Oregon Health & Science University, Department of Surgery, Division of Surgical Oncology, Portland, OR, 97239, USA; OHSU Knight Cancer Institute, Portland, OR, 97239, USA
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3
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Eijkenboom QL, Daxenberger F, Guertler A, Steckmeier S, French LE, Sattler EC. Line-field confocal optical coherence tomography (LC-OCT) for the in vivo examination of nails: Analysis of typical features for the differentiation of nail disorders. J Eur Acad Dermatol Venereol 2024; 38:e413-e416. [PMID: 38059388 DOI: 10.1111/jdv.19641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 11/13/2023] [Indexed: 12/08/2023]
Affiliation(s)
- Q L Eijkenboom
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
| | - F Daxenberger
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
| | - A Guertler
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
| | - S Steckmeier
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
| | - L E French
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - E C Sattler
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
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4
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Perrin C, Coutts M, Boukari F, Ambrosetti D. Onychocytic Matricoma: A Clinical, Dermoscopic, and Pathological Analysis of 14 Cases. Am J Dermatopathol 2024; 46:259-270. [PMID: 38513115 PMCID: PMC11027982 DOI: 10.1097/dad.0000000000002674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
ABSTRACT Onychocytic matricoma (OCM) is a benign neoplasm of the nail matrix. Only 18 cases of this tumor have been reported in the literature to date. We retrospectively analyzed the clinical features of 14 patients with OCM. The most common clinical feature was longitudinal xanthopachyonychia (n = 9), followed by longitudinal leukopachyonychia (=3) and longitudinal pachymelanonychia (n = 2). The most common clinical findings identified following dermoscopy and analysis at high magnification of classical photographs were free-edge thickening of the nail plate without pitting (n = 14), longitudinal ridging (n = 7), round white clods (n = 7), white dots (n = 7), and filiform hemorrhages (n = 7), followed by oval and linear white clods (n = 5), fuzzy lateral border (n = 5), and red-purple blood clods (n = 3). Nail clipping histopathology showed a thickened nail plate with multiple, small, round-to-oval spaces. The tumor expressed immunopositivity for LEF-1. Dermoscopy of the nail plate and nail clipping histology provides useful information with regards to the differential diagnosis with subungual squamous cell carcinoma and nail melanoma. Ex vivo-in vivo correlation facilitates a better dermoscopic assessment of this unique underrecognized disease. However, the differential diagnosis between OCM and onychocytic carcinoma requires biopsy of the tumor. LEF-1 as an onychogenic marker can be used to resolve the differential diagnosis between OCM and subungual longitudinal acanthoma/seborrheic keratosis.
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Affiliation(s)
- Christophe Perrin
- Dermatologists, Laboratoire Central d’Anatomie Pathologique, Nice University Hospital, University of Côte d’Azur (UCA), Nice, France
- Nail's Dermatology Consultations, Cannes, France
| | - Michael Coutts
- Department of Cellular Pathology, Maidstone Hospital, Kent, United Kingdom; and
| | - Feriel Boukari
- Department of Dermatology, Nice University Hospital, University of Côte d’Azur (UCA), Nice, France
| | - Damien Ambrosetti
- Dermatologists, Laboratoire Central d’Anatomie Pathologique, Nice University Hospital, University of Côte d’Azur (UCA), Nice, France
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5
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Veerabagu SA, Zhang J, Krausz AE, Fix WC, Cheng B, Sobanko JF, Etzkorn JR, Shin TM, Higgins HW, Giordano CN, McMurray SL, Walker JL, Miller CJ. Low local recurrence rates after Mohs micrographic surgery for cutaneous squamous cell carcinoma of the nail unit. J Am Acad Dermatol 2024; 90:832-833. [PMID: 38043591 DOI: 10.1016/j.jaad.2023.11.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 11/06/2023] [Accepted: 11/21/2023] [Indexed: 12/05/2023]
Affiliation(s)
- Surya A Veerabagu
- Department of Dermatology, University of New Mexico, Albuquerque, New Mexico
| | - Junqian Zhang
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Aimee E Krausz
- Department of Dermatology, Main Line Health, Paoli, Pennsylvania
| | - William C Fix
- Division of Dermatology, Albert Einstein College of Medicine, Bronx, New York
| | - Brian Cheng
- Department of Medicine, Indiana University, Vincennes, Indiana
| | - Joseph F Sobanko
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeremy R Etzkorn
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Thuzar M Shin
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - H William Higgins
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Cerrene N Giordano
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stacy L McMurray
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joanna L Walker
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Christopher J Miller
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
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Wang P, Ma Y, Zhao Y, Li Y, Tang C, Wang S, Jin S, Wang J, Zhu M, Xie B, Wang P. Single-cell RNA sequencing unveils tumor heterogeneity and immune microenvironment between subungual and plantar melanoma. Sci Rep 2024; 14:7039. [PMID: 38528036 DOI: 10.1038/s41598-024-57640-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 03/20/2024] [Indexed: 03/27/2024] Open
Abstract
Acral melanoma (AM) is a subtype of melanoma with high prevalence in East Asians. AM is characterized by greater aggressiveness and lower survival rates. However, there are still fewer studies on immune mechanisms of AM especially subungual melanoma (SM) versus non-subungual melanoma (NSM). In order to explore tumor heterogeneity and immune microenvironment in different subtypes of AM, we applied single-cell RNA sequencing to 24,789 single cells isolated from the SM and plantar melanoma (PM) patients. Aspects of tumor heterogeneity, melanocytes from PM and SM had significant differences in gene expression, CNV and pathways in which tumor-associated such as NF-kb and Wnt were involved. Regarding the immune microenvironment, PM contained more fibroblasts and T/NK cells. The EPHA3-EFNA1 axis was expressed only in cancer-associated fibroblast (CAF) and melanocytes of PM, and the TIGIT-NECTIN2 axis was expressed in both AM subtypes of T/NK cells and melanocytes. Altogether, our study helps to elucidate the tumor heterogeneity in AM subpopulations and provides potential therapeutic targets for clinical research.
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Affiliation(s)
- Panpan Wang
- Fourth Clinical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yangyang Ma
- Department of Dermatology, Hangzhou Third People's Hospital, Hangzhou, China
| | - Yige Zhao
- Fourth Clinical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yong Li
- Research Center, Shanghai Yeslab Biotechnology, Shanghai, China
| | - Chenyu Tang
- Fourth Clinical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Shiwen Wang
- Fourth Clinical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Sha Jin
- Fourth Clinical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Jiaqi Wang
- Department of Dermatology, Hangzhou Third People's Hospital, Hangzhou, China
| | - Mengyan Zhu
- Department of Dermatology, Hangzhou Third People's Hospital, Hangzhou, China
| | - Bo Xie
- Department of Dermatology, Hangzhou Third People's Hospital, Hangzhou, China
| | - Ping Wang
- Department of Dermatology, Hangzhou Third People's Hospital, Hangzhou, China.
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Joyson D R K, Sasi P K, Prabhu AJ, Ponmar M, Pallapati SCR. Outcomes Following Excision of Toe Glomus Tumors. Foot Ankle Int 2024; 45:243-251. [PMID: 38339796 DOI: 10.1177/10711007231217283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
BACKGROUND Glomus tumors are uncommon tumors and their occurrence in the foot is even less common. Glomus tumors of the toes are often missed, causing delays in diagnosis and treatment. We report an ambispective observational study of glomus tumors of the toes that were treated at our institution. METHODS We reviewed the records of all the patients who underwent excision of toe glomus tumors in our department from January 2010 to September 2022. The follow-up data were collected from the outpatient records and by telephonic interview. Single Assessment Numeric Evaluation (SANE) score, Foot and Ankle Outcome Score (FAOS), and the Foot Function Index (FFI) were collected. RESULTS Out of all the patients treated for glomus tumors, we found that 7 patients had glomus tumors of the toes. Of the 7 patients, 6 were women and 1 was a male. The mean follow-up of our patients was 66.4 months (range, 7-109 months). Of the 7 patients, 1 presented with recurrent glomus tumor 30 months following the primary operation, for which she underwent excision again, after which she was symptom free. Another patient who developed recurrent symptoms on telephonic interview refused any further treatment. Among the 6 patients who were symptom-free at follow-up (including the patient who underwent excision for the recurrent tumor), the median SANE score, and FFI were 99.5 (IQR, 96-100) and 0.5 (IQR, 0-2) respectively. The mean FAOS was 96 (SD, 3.3). CONCLUSION Surgical excision of the subungual toe glomus tumors can be curative. Recurrence of toe glomus tumors was noted in 2 patients (29%), one of whom refused further surgery. Re-excision in the other patient resulted in complete resolution of symptoms. LEVEL OF EVIDENCE Level III, ambispective observational study.
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Affiliation(s)
- Kathir Joyson D R
- Dr Paul Brand Centre for Hand Surgery, Leprosy Reconstructive Surgery and Peripheral Nerve Surgery, Department of Hand Surgery, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Kiran Sasi P
- Dr Paul Brand Centre for Hand Surgery, Leprosy Reconstructive Surgery and Peripheral Nerve Surgery, Department of Hand Surgery, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Anne Jennifer Prabhu
- Department of Pathology, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, India
| | - Madhurima Ponmar
- Department of Pathology, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, India
| | - Samuel C Raj Pallapati
- Dr Paul Brand Centre for Hand Surgery, Leprosy Reconstructive Surgery and Peripheral Nerve Surgery, Department of Hand Surgery, Christian Medical College Hospital, Vellore, Tamil Nadu, India
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8
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Carroll C, Aðalsteinsson J, Prouty M, Duffin KC, Krueger GG, Walsh JA, Feng BJ. Measuring Psoriasis Severity at Home. J Vis Exp 2024. [PMID: 38497631 DOI: 10.3791/66065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024] Open
Abstract
Psoriasis plaque severity metrics, such as induration (thickness), erythema (redness), and desquamation (scaliness), are associated with the subsequent development of psoriatic arthritis (PsA) among cutaneous-only psoriasis patients (patients with skin or nail psoriasis but no psoriatic arthritis). These metrics can be used for PsA screening. However, a key challenge in PsA screening is to optimize accessibility and minimize costs for patients, while also reducing the burden on healthcare systems. Therefore, an ideal screening tool consists of questions that patients can answer without a physician's assistance. Although reference images can be used to help a patient self-assess erythema and desquamation severity, a patient would need a tactile induration reference card to self-assess induration severity. This protocol describes how to create an induration reference card, the Psoriasis Thickness Reference Card, as well as how to use it to assess lesion induration severity. Administration of reference images for erythema and desquamation and a Psoriasis Thickness Reference Card for induration to 27 psoriasis patients showed that patients were moderately successful at self-assessing the severity of these three metrics. These findings support the feasibility of a future PsA screening test that patients can complete without the need for physician assistance.
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Affiliation(s)
| | | | | | | | | | - Jessica A Walsh
- University of Utah School of Medicine; Salt Lake City Veterans Affairs Health
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Cano-Aguilar LE, Corona-Rodarte E, Barrera-Ochoa C, Berumen-Glinz C, Vega-Memije ME, Tosti A, Asz-Sigall D. Onycholemmal horn: A distinctive subungual tumour. J Eur Acad Dermatol Venereol 2024; 38:e94-e95. [PMID: 37596096 DOI: 10.1111/jdv.19445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 08/14/2023] [Indexed: 08/20/2023]
Affiliation(s)
- L E Cano-Aguilar
- Department of Dermatology, Hospital General Dr. Manuel Gea González, Mexico City, Mexico
| | - E Corona-Rodarte
- Dermatology Department, Instituto Dermatológico de Jalisco José Barba Rubio, Zapopan, Mexico
| | - C Barrera-Ochoa
- Department of Dermatology, Hospital General Dr. Manuel Gea González, Mexico City, Mexico
| | - C Berumen-Glinz
- Department of Dermatology, Hospital General Dr. Manuel Gea González, Mexico City, Mexico
| | - M E Vega-Memije
- Department of Dermatology, Hospital General Dr. Manuel Gea González, Mexico City, Mexico
| | - A Tosti
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - D Asz-Sigall
- Trichology Clinic, Dermatology Department, Hospital General Dr. Manuel Gea González, Mexico City, Mexico
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10
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Lee SG, Oh BH, Chung KY, Roh MR. Looking Beyond the Hutchinson Sign: A Retrospective Study of Clinical Factors Indicating the Presence and Invasiveness of Nail Unit Melanoma in Patients With Longitudinal Melanonychia. Dermatol Surg 2024; 50:21-27. [PMID: 38112410 DOI: 10.1097/dss.0000000000003982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
BACKGROUND The data underlying this article are available in the article.Longitudinal melanonychia (LM) presents a challenge because nail unit melanoma (NUM) must be considered as a differential diagnosis. Because nail matrix biopsy may result in nail dystrophy, it is important to distinguish NUM from LM. OBJECTIVE To provide evidence of previously reported clinical factors indicative of NUM in patients with LM. METHODS This was a retrospective study of patients who presented with LM and had biopsy-confirmed NUM from 2005 to 2021. Benign LM was either confirmed by biopsy or considered benign if followed without the need for biopsy. Clinical factors associated with LM and NUM were compared by multivariate regression. RESULTS A total of 177 patients (97 LM and 80 NUM) were included. Multivariate regression showed that high band color intensity (p = .0031), variegation (p = .0005), nail plate splitting (p = .0017), Hutchinson sign (p = .0027), and band change (p = .001) correlated with malignancy. Nail plate splitting was associated with Breslow thickness. CONCLUSION Malignancy should be suspected and biopsy performed in patients with LM and high band color intensity, variegation, nail plate splitting, Hutchinson sign, and band change.
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Affiliation(s)
- Sang Gyun Lee
- Department of Dermatology, Gangnam Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Byung Ho Oh
- Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Kee Yang Chung
- Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Mi Ryung Roh
- Department of Dermatology, Gangnam Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
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Hu J, Ren M, Cai X, Lyu JJ, Shen XX, Kong YY. [Clinicopathological and prognostic features of subungual melanoma in situ]. Zhonghua Bing Li Xue Za Zhi 2023; 52:1006-1011. [PMID: 37805391 DOI: 10.3760/cma.j.cn112151-20230226-00152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 10/09/2023]
Abstract
Objective: To investigate the clinicopathological characteristics, immunohistochemical profiles, molecular features, and prognosis of subungual melanoma in situ (SMIS). Methods: Thirty cases of SMIS were collected in Fudan University Shanghai Cancer Center, Shanghai, China from 2018 to 2022. The clinicopathological characteristics and follow-up data were retrospectively analyzed. Histopathologic evaluation and immunohistochemical studies were carried out. By using Vysis melanoma fluorescence in situ hybridization (FISH) probe kit, combined with 9p21(CDKN2A) and 8q24(MYC) assays were performed. Results: There were 8 males and 22 females. The patients' ages ranged from 22 to 65 years (median 48 years). All patients presented with longitudinal melanonychia involving a single digit. Thumb was the most commonly affected digit (16/30, 53.3%). 56.7% (17/30) of the cases presented with Hutchinson's sign. Microscopically, melanocytes proliferated along the dermo-epithelial junction. Hyperchromatism and nuclear pleomorphism were two of the most common histological features. The melanocyte count ranged from 30 to 185. Most cases showed small to medium nuclear enlargement (29/30, 96.7%). Pagetoid spread was seen in all cases. Intra-epithelial mitoses were identified in 56.7% (17/30) of the cases. Involvement of nailfold was found in 19 cases, 4 of which were accompanied by cutaneous adnexal extension. The positive rates of SOX10, PNL2, Melan A, HMB45, S-100, and PRAME were 100.0%, 100.0%, 96.0%, 95.0%, 76.9%, and 83.3%, respectively. FISH analysis was positive in 6/9 of the cases. Follow-up data were available in 28 patients, and all of them were alive without disease. Conclusions: SMIS mainly shows small to medium-sized cells. High melanocyte count, hyperchromatism, nuclear pleomorphism, Pagetoid spreading, intra-epithelial mitosis, nailfold involvement, and cutaneous adnexal extension are important diagnostic hallmarks. Immunohistochemistry including SOX10 and PRAME, combined with FISH analysis, is valuable for the diagnosis of SMIS.
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Affiliation(s)
- J Hu
- Department of Pathology, Fudan University Shanghai Cancer Center/Department of Oncology, Shanghai Medical College, Fudan University/Institute of Pathology, Fudan University, Shanghai 200032, China
| | - M Ren
- Department of Pathology, Fudan University Shanghai Cancer Center/Department of Oncology, Shanghai Medical College, Fudan University/Institute of Pathology, Fudan University, Shanghai 200032, China
| | - X Cai
- Department of Pathology, Fudan University Shanghai Cancer Center/Department of Oncology, Shanghai Medical College, Fudan University/Institute of Pathology, Fudan University, Shanghai 200032, China
| | - J J Lyu
- Department of Pathology, Fudan University Shanghai Cancer Center/Department of Oncology, Shanghai Medical College, Fudan University/Institute of Pathology, Fudan University, Shanghai 200032, China
| | - X X Shen
- Department of Pathology, Fudan University Shanghai Cancer Center/Department of Oncology, Shanghai Medical College, Fudan University/Institute of Pathology, Fudan University, Shanghai 200032, China
| | - Y Y Kong
- Department of Pathology, Fudan University Shanghai Cancer Center/Department of Oncology, Shanghai Medical College, Fudan University/Institute of Pathology, Fudan University, Shanghai 200032, China
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12
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Niu B, Zheng C, Hu F. Strontium 90 combined with surgery for a patient with giant subungual glomus tumor. Asian J Surg 2023; 46:4549-4551. [PMID: 37244832 DOI: 10.1016/j.asjsur.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 04/28/2023] [Accepted: 05/02/2023] [Indexed: 05/29/2023] Open
Affiliation(s)
- Bin Niu
- Department of Dermatology, Huangshi Central Hospital, Affliated Hospital of Hubei Polytechnic University, Edong Healthcare Group, Hubei Key Laboratory of Kidney Disease Pathogenesis and Intervention, China
| | - Chen Zheng
- Department of Dermatology, Huangshi Central Hospital, Affliated Hospital of Hubei Polytechnic University, Edong Healthcare Group, Hubei Key Laboratory of Kidney Disease Pathogenesis and Intervention, China.
| | - Fei Hu
- School of Electrical Engineering and Automation, Hubei Normal University, Huangshi, Hubei, China
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13
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Lee WQ, Li Y, Yeo NEM. Glomus tumour: an institutional experience of 31 cases. J Orthop Surg Res 2023; 18:741. [PMID: 37777807 PMCID: PMC10541690 DOI: 10.1186/s13018-023-04234-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 09/25/2023] [Indexed: 10/02/2023] Open
Abstract
BACKGROUND Glomus tumour is an uncommon soft tissue tumour which commonly occurs in the distal extremities, particularly the subungual region of the finger. Due to its rarity, there is a paucity of literature concerning glomus tumour. Therefore, this paper aims to report a case series based on our institution's experience. METHODS A retrospective cross sectional study was performed in a single tertiary institution in Singapore. All patients diagnosed with glomus tumour confirmed on histology from January 2019 to October 2022 were included in the study. Patient demographics and clinical information (presenting signs and symptoms, tumour parameters and presence of recurrence) were retrieved from existing medical records. RESULTS A total of 31 cases of glomus tumour were diagnosed from January 2019 to October 2022, and the relevant demographics and clinical presentation were reported. Majority of glomus tumours occurred in the finger (61.3%). Pain was present in almost all the cases (96.8%), while a lump was visible in less than half (48.4%). An average of 44.0 months elapsed before patients were properly diagnosed and treated. There were no cases of recurrence despite involved margins in three cases. CONCLUSION Glomus tumour can be easily missed if clinicians do not have an index of suspicion for it, resulting in delayed treatment. Once diagnosed, glomus tumour can be treated with complete excision with good outcomes.
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Affiliation(s)
- Wen Qiang Lee
- Department of Orthopaedics, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore.
| | - Yihan Li
- Department of Anatomical Pathology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Nicholas Eng Meng Yeo
- Department of Orthopaedics, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
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14
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Williams ML, Parupia Y, King CM, Dobbs TG, Peng P. Foot Melanoma Localized to Subungual Toe Location Portends Poorer Prognosis. J Foot Ankle Surg 2023; 62:840-844. [PMID: 37169120 DOI: 10.1053/j.jfas.2023.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 03/12/2023] [Accepted: 04/30/2023] [Indexed: 05/13/2023]
Abstract
Our group previously reported that melanoma of the foot is associated with advanced disease on diagnosis and decreased survival. Lesions localized to the toe appeared to have the worst outcomes. In this study, we both expanded our study to include a 10-year population of patient with invasive melanoma of the foot and ankle and investigated additional factors associated with prognosis. Between January 2007 and December 2016, 211 patients underwent biopsy diagnosis and surgery for invasive melanoma in the BLANK health care system. Demographic, pathologic, staging, and localization characteristics were studied for overall survival. Lesions were localized to dorsal foot, plantar foot, toe (nonsubungual), and toe (subungual) locations. Multivariable analysis found Breslow depth, ulceration, lymph node involvement, and subungual toe location to be associated with poorer survival. Overall survival rate for foot melanoma was 70.6%. Overall survival for nonsubungual toe melanoma was 60.7%, compared to 53.1% for subungual toe melanoma. Of the subungual melanomas, 37.5% of presented as deep lesions with a Breslow depth >4.0 mm. Subungual melanoma was statistically significant for and found to be an independent prognostic factor associated with poorer survival and advanced disease. Based on the results of this study, there should be a low threshold to biopsy suspicious lesions of the toe and foot with particular attention to be dedicated to subungual lesions.
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Affiliation(s)
- Mitzi L Williams
- Attending Foot & Ankle Surgeon, Kaiser Foundation Hospital Oakland, Oakland, CA.
| | - Yaseer Parupia
- Attending Foot & Ankle Surgeon, Kaiser Foundation Hospital Sacramento, Sacramento, CA
| | - Christy M King
- Attending Foot & Ankle Surgeon, Kaiser Foundation Hospital Oakland, Oakland, CA
| | - Thomas G Dobbs
- Undergraduate Student at Notre Dame, West Palm Beach, FL
| | - Peter Peng
- Attending Oncology/General Surgeon, Kaiser Foundation Hospital Oakland, Oakland, CA
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15
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Arasu A, Howard A, Tan CG, Prakash S, Kern JS. Clinical and dermoscopic features of nail unit melanoma in an Australian nail clinic cohort. Australas J Dermatol 2023; 64:417-422. [PMID: 37102442 DOI: 10.1111/ajd.14057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/02/2023] [Indexed: 04/28/2023]
Abstract
Nail unit melanoma carries diagnostic challenges conferring with its poor prognosis. This audit aims to characterise both clinical and dermoscopic features of nail unit malignant lesions and compare them with biopsied benign lesions. It focuses on informing future practice by aiding in the stratification and recognition of malignant diagnostic patterns in the Australian context.
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Affiliation(s)
- Alexis Arasu
- Department of Dermatology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Anne Howard
- Department of Dermatology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
- Skin Health Institute, Carlton, Victoria, Australia
| | - Chin-Guan Tan
- Melbourne Pathology (Sonic Healthcare), Collingwood, Victoria, Australia
| | - Saurabh Prakash
- Melbourne Pathology (Sonic Healthcare), Collingwood, Victoria, Australia
| | - Johannes S Kern
- Department of Dermatology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
- Skin Health Institute, Carlton, Victoria, Australia
- Faculty of Medicine, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Dermatology, Alfred Health, Melbourne, Victoria, Australia
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16
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Folle L, Fenzl P, Fagni F, Thies M, Christlein V, Meder C, Simon D, Minopoulou I, Sticherling M, Schett G, Maier A, Kleyer A. DeepNAPSI multi-reader nail psoriasis prediction using deep learning. Sci Rep 2023; 13:5329. [PMID: 37005487 PMCID: PMC10067940 DOI: 10.1038/s41598-023-32440-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/28/2023] [Indexed: 04/04/2023] Open
Abstract
Nail psoriasis occurs in about every second psoriasis patient. Both, finger and toe nails can be affected and also severely destroyed. Furthermore, nail psoriasis is associated with a more severe course of the disease and the development of psoriatic arthritis. User independent quantification of nail psoriasis, however, is challenging due to the heterogeneous involvement of matrix and nail bed. For this purpose, the nail psoriasis severity index (NAPSI) has been developed. Experts grade pathological changes of each nail of the patient leading to a maximum score of 80 for all nails of the hands. Application in clinical practice, however, is not feasible due to the time-intensive manual grading process especially if more nails are involved. In this work we aimed to automatically quantify the modified NAPSI (mNAPSI) of patients using neuronal networks retrospectively. First, we performed photographs of the hands of patients with psoriasis, psoriatic arthritis, and rheumatoid arthritis. In a second step, we collected and annotated the mNAPSI scores of 1154 nail photos. Followingly, we extracted each nail automatically using an automatic key-point-detection system. The agreement among the three readers with a Cronbach's alpha of 94% was very high. With the nail images individually available, we trained a transformer-based neural network (BEiT) to predict the mNAPSI score. The network reached a good performance with an area-under-receiver-operator-curve of 88% and an area-under precision-recall-curve (PR-AUC) of 63%. We could compare the results with the human annotations and achieved a very high positive Pearson correlation of 90% by aggregating the predictions of the network on the test set to the patient-level. Lastly, we provided open access to the whole system enabling the use of the mNAPSI in clinical practice.
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Affiliation(s)
- Lukas Folle
- Pattern Recognition Lab, Department of Computer Science, Friedrich-Alexander-Universität Erlangen-Nürnberg, Martensstraße 3, 91058, Erlangen, Germany.
| | - Pauline Fenzl
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
- Deutsches Zentrum Immuntherapie, Friedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Filippo Fagni
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
- Deutsches Zentrum Immuntherapie, Friedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Mareike Thies
- Pattern Recognition Lab, Department of Computer Science, Friedrich-Alexander-Universität Erlangen-Nürnberg, Martensstraße 3, 91058, Erlangen, Germany
| | - Vincent Christlein
- Pattern Recognition Lab, Department of Computer Science, Friedrich-Alexander-Universität Erlangen-Nürnberg, Martensstraße 3, 91058, Erlangen, Germany
| | - Christine Meder
- Deutsches Zentrum Immuntherapie, Friedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
- Department of Dermatology, Friedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - David Simon
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
- Deutsches Zentrum Immuntherapie, Friedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Ioanna Minopoulou
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
- Deutsches Zentrum Immuntherapie, Friedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Michael Sticherling
- Deutsches Zentrum Immuntherapie, Friedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
- Department of Dermatology, Friedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Georg Schett
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
- Deutsches Zentrum Immuntherapie, Friedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Andreas Maier
- Pattern Recognition Lab, Department of Computer Science, Friedrich-Alexander-Universität Erlangen-Nürnberg, Martensstraße 3, 91058, Erlangen, Germany
| | - Arnd Kleyer
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
- Deutsches Zentrum Immuntherapie, Friedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
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17
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Peck GM, Wang Y, Fleischer AB, Lipner SR. Practice region and density, male sex, and specialty predict frequent performers of nail biopsies. J Am Acad Dermatol 2023; 88:688-690. [PMID: 35817331 DOI: 10.1016/j.jaad.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 06/22/2022] [Accepted: 07/03/2022] [Indexed: 11/17/2022]
Affiliation(s)
| | - Yu Wang
- Department of Dermatology, Wake Forest University, Winston-Salem, North Carolina
| | - Alan B Fleischer
- Department of Dermatology, University of Cincinnati, Cincinnati, Ohio
| | - Shari R Lipner
- Department of Dermatology, Weill Cornell Medicine, New York, New York.
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18
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Sil A, Ghosh S, Das A, Chandra A. Transverse erythronychia: A unique nail manifestation of COVID-19 infection and brief review of COVID-19 associated nail changes. J R Coll Physicians Edinb 2022; 52:320-323. [PMID: 36476144 PMCID: PMC9742509 DOI: 10.1177/14782715221142559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Over the past 2 years, a plethora of mucocutaneous manifestations have been described to be associated with coronavirus 2019 (COVID-19) infection. Nail changes attributed to COVID-19 have rarely been documented in the literature. We describe here a unique nail finding 'transverse erythronychia' due to COVID-19 and review the literature on the diverse nail pathology attributed to the disease.
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Affiliation(s)
- Abheek Sil
- Department of Dermatology, Venereology,
and Leprosy, RG Kar Medical College and Hospital, Kolkata, India
| | - Shouvik Ghosh
- Department of Dermatology, Venereology,
and Leprosy, KPC Medical College and Hospital, Kolkata, India
| | - Anupam Das
- Department of Dermatology, Venereology,
and Leprosy, KPC Medical College and Hospital, Kolkata, India
| | - Atanu Chandra
- Department of Internal Medicine, RG Kar
Medical College and Hospital, Kolkata, India
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19
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Wen Y, Lu Z, Li X, Fan X. Ultrasound-guided radiofrequency thermocoagulation for subungual glomus tumor. Asian J Surg 2022; 46:2272-2273. [PMID: 36528527 DOI: 10.1016/j.asjsur.2022.11.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 11/30/2022] [Indexed: 12/16/2022] Open
Affiliation(s)
- Yuanyuan Wen
- Department of Pain Medicine, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, 450052, China; Henan Province International Joint Laboratory of Pain, Cognition and Emotion, Zhengzhou, Henan Province, China
| | - Zhongyuan Lu
- Department of Pain Medicine, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, 450052, China; Henan Province International Joint Laboratory of Pain, Cognition and Emotion, Zhengzhou, Henan Province, China
| | - Xinxin Li
- Department of Pain Medicine, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, 450052, China; Henan Province International Joint Laboratory of Pain, Cognition and Emotion, Zhengzhou, Henan Province, China
| | - Xiaochong Fan
- Department of Pain Medicine, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, 450052, China; Henan Province International Joint Laboratory of Pain, Cognition and Emotion, Zhengzhou, Henan Province, China.
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20
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Hetterschijt CRM, Pasch MC. [Nail disorders in daily practice]. Ned Tijdschr Geneeskd 2022; 166:D6766. [PMID: 36300431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Familiarity with common nail disorders enables the clinician to diagnose and treat nail disorders and to recognize red-flag conditions. Knowledge of the anatomy of the nail unit is essential to understand the origin of nail disorders. This article focuses on neoplasms, abnormalities of nail color and shape, infections, and inflammatory conditions of the nail unit. There are various neoplasms of and around the nail unit, like squamous cell carcinoma (in situ), melanoma, and benign neoplasms such as mucous cyst, subungual exostosis, glomus tumor, onychopapilloma and fibro(kerato)ma. The most common deviating colors of the nail are red, white and brown-black. Abnormalities of nail color and shape may indicate an underlying systemic disease. Infections of the nail unit include onychomycosis, acute paronychia, pseudomonas nail infection and verruca vulgaris. The inflammatory conditions we discuss in this article are chronic paronychia, psoriasis, alopecia areata and lichen planus.
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21
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Pham F, Boespflug A, Duru G, Phan A, Poulalhon N, Weiler L, Tanaka M, Lallas A, Ogata D, Davaine AC, Bahadoran P, Balguerie X, Kamińska-Winciorek G, Tromme I, Correia O, Kim MB, Marghoob AA, Linda Martin, Guitera P, Meziane M, Miquel J, Mun JH, Argenziano G, Bessis D, Bourke J, Mijuskovic Z, Chiaverini C, Corven-Benoit C, Droitcourt C, Skowron F, Marque M, Zalaudek I, Rosendahl C, Moreno-Ramirez D, Vabres P, Haenssle H, Malvehy J, Puig S, Robert C, Schopf TR, Scope A, Dalle S, Thomas L. Dermatoscopic and clinical features of congenital or congenital-type nail matrix nevi: A multicenter prospective cohort study by the International Dermoscopy Society. J Am Acad Dermatol 2022; 87:551-558. [PMID: 35104588 PMCID: PMC10035057 DOI: 10.1016/j.jaad.2022.01.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 01/03/2022] [Accepted: 01/14/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Congenital nail matrix nevi (NMN) are difficult to diagnose because they feature clinical characteristics suggestive of adult subungual melanoma. Nail matrix biopsy is difficult to perform, especially in children. OBJECTIVE To describe the initial clinical and dermatoscopic features of NMN appearing at birth (congenital) or after birth but before the age of 5 years (congenital-type). METHODS We conducted a prospective, international, and consecutive data collection in 102 hospitals or private medical offices across 30 countries from 2009 to 2019. RESULTS There were 69 congenital and 161 congenital-type NMNs. Congenital and congenital-type NMN predominantly displayed an irregular pattern of longitudinal microlines (n = 146, 64%), reminiscent of subungual melanoma in adults. The distal fibrillar ("brush-like") pattern, present in 63 patients (27.8%), was more frequently encountered in congenital NMN than in congenital-type NMN (P = .012). Moreover, congenital NMN more frequently displayed a periungual pigmentation (P = .029) and Hutchinson's sign (P = .027) than did congenital-type NMN. LIMITATIONS Lack of systematic biopsy-proven diagnosis and heterogeneity of clinical and dermatoscopic photographs. CONCLUSION Congenital and congenital-type NMN showed worrisome clinical and dermatoscopic features similar to those observed in adulthood subungual melanoma. The distal fibrillar ("brush-like") pattern is a suggestive feature of congenital and congenital-type NMN.
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Affiliation(s)
- Félix Pham
- Service de Dermatologie, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France; Université Claude-Bernard-Lyon Lyon, Lyon, France
| | - Amélie Boespflug
- Service de Dermatologie, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France; Université Claude-Bernard-Lyon Lyon, Lyon, France
| | | | - Alice Phan
- Nephrology-Rheumatology-Dermatology Department, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
| | - Nicolas Poulalhon
- Service de Dermatologie, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Laura Weiler
- Service de Dermatologie, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Masaru Tanaka
- Department of Dermatology, Saitama Medical University, Japan
| | - Aimilios Lallas
- First Department of Dermatology, School of Medicine, Faculty of Health Sciences, Aristotle University, Thessaloniki, Greece
| | - Dai Ogata
- Department of Dermatologic oncology, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | | | - Philippe Bahadoran
- Centre Hospitalier Universitaire Nice, Department of Dermatology, Université Nice Côte d'Azur, Nice, France
| | - Xavier Balguerie
- Department of Dermatology, Rouen University Medical Center, Rouen, France
| | - Grażyna Kamińska-Winciorek
- Department of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie Memorial Cancer Center and the Institute of Oncology, Gliwice Branch, Poland
| | - Isabelle Tromme
- Dermatology Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Osvaldo Correia
- Centro Dermatologia Epidermis, Instituto CUF and Faculty of Medicine of University of Porto, Porto, Portugal
| | - Moon-Bum Kim
- Department of Dermatology, School of Medicine, Pusan National University Medical Research Institute, Pusan National University, Busan, Korea
| | - Ashfaq A Marghoob
- Memorial Sloan Kettering Skin Cancer Center, Hauppauge, New York, USA
| | - Linda Martin
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
| | - Pascale Guitera
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
| | - Mariame Meziane
- Department of Dermatology, Ibn Sina University Hospital, Rabat, Morocco; Faculty of Medicine and Pharmacy, Mohammed V university, Rabat, Morocco
| | - Juliette Miquel
- Unit of Pediatric Dermatology, Saint-Pierre University Hospital, Saint-Pierre, la Réunion, France
| | - Je-Ho Mun
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
| | - Giuseppe Argenziano
- Dermatology Unit, Department of Mentals and Physical Health and Preventive medicine, University of Campania Luigi Vanvitelli Naples, Napoli, Italy
| | - Didier Bessis
- Service de Dermatologie, Hôpital Saint-Eloi et Hôpital Universitaire de Montpellier, Montpellier, France
| | - Johnny Bourke
- Dermatology Department, South Infirmary-Victoria University Hospital, Cork, Ireland
| | - Zeljko Mijuskovic
- Department of Dermatology and Venereology,School of Medicine, Military Medical Academy, Belgrade, Serbia
| | - Christine Chiaverini
- Department of Dermatology, Centre Hospitalier Universitaire de Nice, Nice, France
| | | | - Catherine Droitcourt
- Department of Dermatology, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - François Skowron
- Service de dermatologie, Hôpitaux Drôme Nord, Romans sur Isère, Romans sur Isère, France
| | - Myriam Marque
- Department of Dermatology, Caremeau Hospital, Centre Hospitalier Universitaire de Nîmes, Nîmes, France
| | - Iris Zalaudek
- Department of Dermatology, Medical University of Trieste, Trieste, Italy
| | - Cliff Rosendahl
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | | | - Pierre Vabres
- Centre de Référence MAGEC, Service de Dermatologie, Centre Hospitalier Universitaire Dijon Bourgogne, Dijon, France
| | - Holger Haenssle
- Universitäts-Hautklinik Heidelberg, Ruprecht-Karl Universität, Heidelberg, Germany
| | - Josep Malvehy
- Melanoma Unit, Department of Dermatology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Susana Puig
- Melanoma Unit, Department of Dermatology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Caroline Robert
- Department of Medicine, Dermatology Service, Gustave Roussy and Paris-Saclay University, INSERM U981, Villejuif, France
| | - Thomas R Schopf
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
| | - Alon Scope
- The Kittner Skin Cancer Screening and Research Institute, Sheba Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Stéphane Dalle
- Service de Dermatologie, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France; Université Claude-Bernard-Lyon Lyon, Lyon, France
| | - Luc Thomas
- Service de Dermatologie, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France; Université Claude-Bernard-Lyon Lyon, Lyon, France.
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22
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Parra O, Linos K, Li Z, Yan S. PRAME expression in melanocytic lesions of the nail. J Cutan Pathol 2022; 49:610-617. [PMID: 35294053 DOI: 10.1111/cup.14226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 02/22/2022] [Accepted: 03/13/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Subungual melanoma can be diagnostically challenging. We evaluated the potential of PReferentially expressed Antigen for MElanoma (PRAME) immunoreactivity for differentiating benign from malignant nail melanocytic lesions. METHODS Sixty cases were identified (10 invasive melanomas, 8 melanomas in situ, 14 nevi, 12 cases of lentigo, and 16 of melanocytic activation). Percentage of PRAME-positive melanocytes was evaluated as follows: 0 no staining, 1+ 1%-25%, 2+ 26%-50%, 3+ 51%-75%, and 4+ >75%. A combined score of both percentage and intensity was also evaluated. RESULTS The difference in PRAME expression between malignant and benign lesions was statistically significant (p < 0.0001). The degree of PRAME expression significantly correlated with patients' age and clinical size. When based on percentage score, 61.1% of melanomas showed a 4+ score, 16.7% showed a 3+ score, 11.1% showed a 1+ score, and 11.1% was negative; 69.0% of the benign lesions was negative, 23.8% showed a 1+ score, 4.8% showed a 2+ score, and 2.4% showed a 4+ score. When the cutoff value for malignancy decreased from 4+ to 3+, the sensitivity increased from 61.1% to 77.8%, while specificity remained 97.6%. Combined score results were similar. CONCLUSIONS PRAME is a relatively sensitive and highly specific marker in differentiating benign from malignant nail melanocytic lesions. However, correlation with morphology is imperative.
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Affiliation(s)
- Ourania Parra
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Konstantinos Linos
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Zhongze Li
- Department of Biomedical Data Science, Geisel Scool of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Shaofeng Yan
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
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23
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Inthasot S, André J, Richert B. Causes of longitudinal nail splitting: a retrospective 56-case series with clinical pathological correlation. J Eur Acad Dermatol Venereol 2022; 36:744-753. [PMID: 35088456 DOI: 10.1111/jdv.17967] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 12/07/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Split nail (SN) is a rare type of nail fragility syndrome, characterized by a longitudinal fissure involving the entire thickness of the nail plate. Longitudinal nail splitting may be caused by direct injury to the nail plate or matrix insult. Few articles have been published on the topic, most were related to the traumatic aetiology. Some case reports mention tumours and inflammatory disorders as other causes. OBJECTIVES AND METHODS The aim of this retrospective study was to analyse the clinical and histopathological features of 56 SN collected at the nail consultation of the dermatology department at Saint Pierre University Hospital in Brussels, between 1997 and 2019. RESULTS Fifty-six patients were included (34 women and 22 men) with median age of 44.2 years. The fingernails were 3.2 times more frequently affected than toenails, especially the thumb. The most frequent aetiologies were tumours (45.6%), inflammatory diseases (26.3%) and traumas (19.3%). Congenital (5.3%) and systemic disorders (3.5%) were rarer causes. Histopathological slide review confirmed that alteration of the nail matrix integrity causes split nail, resulting either from matrix stretching by an underlying tumour or from impairment of the keratinization process by inflammatory diseases, melanocytic tumours and Bowen's disease. CONCLUSIONS This study is the largest case series of longitudinal nail splitting to date. It is the first to gather nail disorders causing SN with their clinical pathological correlation. The most common causes are traumatisms, tumours and inflammatory disorders. Congenital and systemic disorders are rarer. Tumours are responsible for half of the cases from which one third are malignant, mainly melanoma. When facing a monodactylic SN, benign as well as malignant tumours should be ruled out before concluding to traumatic aetiology.
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Affiliation(s)
- S Inthasot
- Dermatology Department, St-Pierre, Brugmann and Queen Fabiola Children University Hospitals, Université Libre de Bruxelles, Bruxelles, Belgium
| | - J André
- Dermatology Department, St-Pierre, Brugmann and Queen Fabiola Children University Hospitals, Université Libre de Bruxelles, Bruxelles, Belgium
| | - B Richert
- Dermatology Department, St-Pierre, Brugmann and Queen Fabiola Children University Hospitals, Université Libre de Bruxelles, Bruxelles, Belgium
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Kim YJ, Jung CJ, Na H, Lee WJ, Chang SE, Lee MW, Park CS, Lim Y, Won CH. Cyclin D1 and PRAME expression in distinguishing melanoma in situ from benign melanocytic proliferation of the nail unit. Diagn Pathol 2022; 17:41. [PMID: 35484605 PMCID: PMC9047257 DOI: 10.1186/s13000-022-01218-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 04/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Distinguishing benign lesion from early malignancy in melanocytic lesions of the nail unit still remains a diagnostic challenge, both clinically and histopathologically. While several immunohistochemistry (IHC) stainings have been suggested to help discriminate benign subungual melanocytic proliferation (SMP) and subungual melanoma in situ (MIS), the diagnostic utility of IHC staining for cyclin D1 and PRAME has not been thoroughly investigated in melanocytic lesions of nail unit. METHODS This retrospective study included cases of benign SMP and subungual MIS confirmed by biopsy at Asan Medical Center from January 2016 to December 2020. Cases of melanocytic activation without proliferation and melanoma where dermal invasion was identified were excluded. Cyclin D1 and PRAME expression was assessed by counting proportion of melanocytes with nuclear positivity under 200x magnification. RESULTS A total of 14 patients with benign SMP and 13 patients with subungual MIS were included in this study. 11 patients with benign SMP (71.4%) and 5 patients with subungual MIS (38.5%) showed > 60% nuclear immunostaining for cyclin D1, respectively. While 13 patients with benign SMP (92.9%) showed totally negative staining for PRAME, 10 patients with subungual MIS (76.9%) exhibited > 50% nuclear immunostaining for PRAME. Using the cutoff of 10%, PRAME exhibited good overall discrimination between benign SMP and subungual MIS (AUC = 0.849, 95% CI = 0.659-0.957). CONCLUSIONS This study suggests that PRAME IHC staining as a reliable discriminator in distinguishing subungual MIS from benign SMP.
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Affiliation(s)
- Young Jae Kim
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic- ro 43 gil, Songpa-gu, Seoul, Korea
| | - Chang Jin Jung
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic- ro 43 gil, Songpa-gu, Seoul, Korea
| | - Hyoungmin Na
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic- ro 43 gil, Songpa-gu, Seoul, Korea
| | - Woo Jin Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic- ro 43 gil, Songpa-gu, Seoul, Korea
| | - Sung Eun Chang
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic- ro 43 gil, Songpa-gu, Seoul, Korea
| | - Mi Woo Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic- ro 43 gil, Songpa-gu, Seoul, Korea
| | - Chan-Sik Park
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic- ro 43 gil, Songpa-gu, Seoul, Korea
| | - Youngkyoung Lim
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic- ro 43 gil, Songpa-gu, Seoul, Korea.
- Present address: Department of Dermatology, Seoul National University Hospital, 101, Daehak ro, Jongno gu, Seoul, Korea.
| | - Chong Hyun Won
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic- ro 43 gil, Songpa-gu, Seoul, Korea.
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Lee JS, Kim S, Kim DH, Lee JW, Mun JH, Lee SH. Clinical features and natural course of pediatric longitudinal melanonychia: A retrospective cohort study in Korea. J Am Acad Dermatol 2022; 87:366-372. [PMID: 35395360 DOI: 10.1016/j.jaad.2022.03.058] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 03/15/2022] [Accepted: 03/24/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Large studies on the clinical features and natural course of pediatric longitudinal melanonychia (LM) are lacking. OBJECTIVE To investigate the clinical features and natural course of pediatric LM METHODS: Retrospective cohort analysis of pediatric patients (age ≤18 years) with LM RESULTS: We examined 703 LM lesions in 381 children. Single, narrow, and homogeneously pigmented fingernail lesions were most frequently seen. Our results suggested that within 3, 4.5, and 9.5 years after onset, approximately 3%, 5%, and 10% of LM lesions, respectively, will completely regress and that single, left-sided, and homogeneously pigmented lesions are more likely to completely disappear. Age of onset, sex, finger/toe position, Hutchinson's sign, and nail dystrophy were not associated with complete regression. During follow up, most cases showed no change in color or width between the first and last visit, and early darkening/wider before stabilization or lightening/narrowing was common. Pigmentation becoming lighter was associated with complete regression; change in width was not. LIMITATIONS Retrospective study at a tertiary center CONCLUSION: Our results suggest that clinicians ought to follow up pediatric LM without intervention for several years, even if lesions grow darker or wider. Single, left-sided, and homogeneously colored lesions are more likely to regress.
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Affiliation(s)
- Ji Su Lee
- Department of Dermatology, Seoul National University Hospital, Seoul, Korea
| | - Sungbum Kim
- Department of Dermatology, Seoul National University Hospital, Seoul, Korea
| | - Dong Hyo Kim
- Department of Dermatology, Seoul National University Hospital, Seoul, Korea
| | - Ji Won Lee
- Department of Dermatology, Seoul National University Hospital, Seoul, Korea
| | - Je-Ho Mun
- Department of Dermatology, Seoul National University Hospital, Seoul, Korea; Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea; Institute of Human-Environmental Interface Biology, Medical Research Center, Seoul National University, Seoul, Korea
| | - Si-Hyung Lee
- Department of Dermatology, Seoul National University Hospital, Seoul, Korea; Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea; Institute of Human-Environmental Interface Biology, Medical Research Center, Seoul National University, Seoul, Korea.
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Falcone MO. [Glomus tumors of the fingers]. Rev Prat 2022; 72:313-316. [PMID: 35638965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
"Glomus tumors of the fingers. Glomus tumors of the fingers are benign lesions. The main symptom is a paroxysmal pain with particular hypersensiti¬vity to temperature changes. They are rare in their census, but there is very probably a very high rate of misdiagnosis, due to the very ignorance of their existence by the medical corpus. Their diagnosis is based on a typical clinical exami¬nation and characteristic imaging. The only treatment is their complete surgical resection, which is essential for recovery. Different surgical techniques have been described in the medical literature to achieve a painless finger without nail deformity after tumor resection, while limiting recurrences."
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Affiliation(s)
- Marc-Olivier Falcone
- "Clinique Jouvenet, Capio-Ramsay Santé, Paris Hôpital privé Paul-d'Égine, SOS Mains, Val-de-Marne, Capio-Ramsay Santé, Champigny-sur-Marne Maison de santé pluridisciplinaire " La Francilienne ", SOS Mains, antenne Seine-et-Marne, Pontault-Combault"
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Chen J, Wang X, Zhu Y, He J, Rao Y, Liu K. Nail matrix scars that result in nail dystrophy resemble cutaneous scars: A new nail trauma model. Burns 2022; 48:396-403. [PMID: 34670717 DOI: 10.1016/j.burns.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 05/05/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Few studies have described how the injury affects the nail soft tissue under the nail plate. Nail matrix scar is poorly known. OBJECTIVE To establish a stable rat nail loss model in a simple way, and to discuss the comparability of this model. METHODS A sterile cotton swab dipped in a 10% NaOH solution was used to burn the entire nail matrix and bed plane region, and the specimens were examined on day 3, 7, 14, and 28. RESULTS After avulsion of the nail plate, the eponychia and matrix stuck together without any tissue destruction. On day 28, all claws of the experimental group were observed to be permanently damaged, except for one claw malformed regeneration. All impaired nail regeneration had deficiency or functional loss of NMSCs and shared similar characteristics with the cutaneous scars. CONCLUSIONS The scar formation of nail matrix was a fundamental reason to nail deficiency of rat or human, providing a research basis for further mechanism or treatment study of nail defect diseases.
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Affiliation(s)
- Jun Chen
- Department of Dermatology, Shanghai Ninth People's Hospital, Affiliated to Shanghai Jiaotong University School of Medicine, Center for Specialty Strategy Research of Shanghai JiaoTong University China Hospital Development Institute, Shanghai 200011, PR China
| | - Xue Wang
- Department of Dermatology, Shanghai Ninth People's Hospital, Affiliated to Shanghai Jiaotong University School of Medicine, Center for Specialty Strategy Research of Shanghai JiaoTong University China Hospital Development Institute, Shanghai 200011, PR China
| | - Yueqian Zhu
- Department of Dermatology, The First Affiliated Hospital of Soochow University, Suzhou 215000, PR China
| | - Jing He
- Department of Anatomy and Neurobiology, Tongji University School of Medicine, Shanghai, PR China
| | - Yamin Rao
- Department of Pathology, Shanghai Ninth People's Hospital, Affiliated to Shanghai Jiaotong University School of Medicine, Center for Specialty Strategy Research of Shanghai JiaoTong University China Hospital Development Institute, Shanghai 200011, PR China.
| | - Ke Liu
- Department of Dermatology, Shanghai Ninth People's Hospital, Affiliated to Shanghai Jiaotong University School of Medicine, Center for Specialty Strategy Research of Shanghai JiaoTong University China Hospital Development Institute, Shanghai 200011, PR China.
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Abstract
BACKGROUND Amputation has been the standard treatment for subungual melanoma. Although there is growing attention toward a more conservative functional surgery, specific operative techniques are not yet available. OBJECTIVE We aimed to provide objective measurements for use in functional surgery by analyzing the anatomy of the nail apparatus obtained from 21 cadavers. MATERIALS AND METHODS Nailbed thickness was histologically measured in each subunit, and skin surface anatomy was evaluated to determine the proximal resection margin. Immunohistochemical staining was performed to analyze microvessel distribution according to the nail subunit. RESULTS The nailbed thickness was the thinnest at the most proximal point of the nail matrix (thumbs, 1.10 ± 0.42 mm; big toes, 1.15 ± 0.37 mm) and the thickest at the hyponychium (thumbs, 2.86 ± 0.82 mm; big toes, 2.72 ± 0.84 mm). The distance from the eponychium to the skin surface closest to the bony cortex of extensor tendon insertion was 6.92 ± 5.13 mm in thumbs and 5.14 ± 1.59 mm in big toes. The median microvessel density was the highest at the hyponychium (25.74 vessels/mm2) and lowest at the germinal matrix (16.26 vessels/mm2) (p < .05). CONCLUSION This histological study offers practical tips, including those to help decide the proximal and deep resection margins, in functional surgery.
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Affiliation(s)
- Byung Jun Kim
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jinhyun Kim
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Julong Hu
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yoonjin Kwak
- Department of Pathology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sung Tack Kwon
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul, Republic of Korea
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Oh SJ, Lee J, Park S, Park JH, Lee D. Hutchinson Sign: Biopsy May Assist in Diagnosis of Subungual Melanoma in Situ. Dermatol Surg 2022; 48:28-31. [PMID: 34608084 DOI: 10.1097/dss.0000000000003233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Early and accurate diagnosis of subungual melanoma (SUM) through histopathologic examination is critical, but lack of clinical suspicion leads to delays in diagnosis. Hutchinson sign (HS) can be one of the important clinical indicators for diagnosing SUM. OBJECTIVE To evaluate the diagnostic value of small biopsies of HS for detecting SUM in situ. METHODS We retrospectively evaluated 12 patients who were diagnosed as SUM in situ and underwent punch biopsy at HS areas. Clinical features, dermoscopic findings, and histopathologic findings in HS regions were analyzed. RESULTS In most cases, HS was seen in hyponychium (11/12, 91.7%) with 1 case found in proximal nail fold, and 1 case in both the hyponychium and proximal nail fold. Dermoscopic features of HS showed irregular diffuse pigmentation (12/12, 100%) and parallel ridge pattern (7/12, 58.3%). Histopathologically, all cases showed irregularly scattered atypical melanocytes with hyperchromatic nuclei. Two cases showed subtle changes in melanocytes with little nuclear atypia, but additional section specimen showed more definitive findings of SUM in situ. CONCLUSION We present a supplementary biopsy technique for diagnosing SUM. Biopsy of HS may help in the diagnosis of SUM.
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Affiliation(s)
- Se Jin Oh
- All authors are affiliated with the Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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LaRocca CJ, Lai L, Nelson RA, Modi B, Crawford B. Subungual Melanoma: A Single Institution Experience. Med Sci (Basel) 2021; 9:medsci9030057. [PMID: 34564082 PMCID: PMC8482220 DOI: 10.3390/medsci9030057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/01/2021] [Accepted: 09/01/2021] [Indexed: 11/16/2022] Open
Abstract
Despite the changing paradigms of melanoma treatment in recent years, there remains a relative paucity of data regarding subungual melanoma in the literature. From 2002–2018, 25 patients with subungual melanoma were surgically treated at our facility. A retrospective chart review was conducted to collect relevant demographic, clinical, pathologic, and outcomes data. The median age at diagnosis was 69 years. Most patients (60%) were male, and the melanoma lesion was most often located on the foot (68%). Acral-lentiginous was the most common histologic subtype (59%), and the median Breslow thickness was 3.4 mm. Fifteen patients (63%) underwent a sentinel lymph node biopsy as part of their surgical resection, and four of these patients (27%) had metastatic disease in the lymph nodes. In total, 10 patients underwent lymph node dissection of the involved basin. The median follow up was 21 months in this patient population. Age, gender, tumor location, ulceration, and lesion histology were not significantly associated with recurrence free survival (RFS). Increasing Breslow thickness was found to be significantly associated with shorter RFS (HR: 1.07, CI: 1.03–1.55). In total, 13 patients developed a disease recurrence, and RFS rates were 66% at 1 year and 40% at 3 years. Additionally, 91 and 37% of patients were alive at one year and three years, respectively. Subungual melanomas are rare lesions that often have a more advanced stage at diagnosis, which contributes to the poor prognosis of these cutaneous malignancies.
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Affiliation(s)
- Christopher J. LaRocca
- Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA
- Correspondence: (C.J.L.); (B.C.); Tel.: +1-612-625-2991 (C.J.L.); +1-424-259-9823 (B.C.)
| | - Lily Lai
- City of Hope National Medical Center, Department of Surgery, Duarte, CA 91010, USA; (L.L.); (B.M.)
| | - Rebecca A. Nelson
- City of Hope National Medical Center, Department of Computational and Quantitative Medicine, Duarte, CA 91010, USA;
| | - Badri Modi
- City of Hope National Medical Center, Department of Surgery, Duarte, CA 91010, USA; (L.L.); (B.M.)
| | - Brooke Crawford
- UCLA Medical Center, Department of Orthopedic Surgery, Santa Monica, CA 90404, USA
- Correspondence: (C.J.L.); (B.C.); Tel.: +1-612-625-2991 (C.J.L.); +1-424-259-9823 (B.C.)
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31
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Yoo H, Kim H, Kwon ST, Jo SJ, Mun JH, Lee C, Kwak Y, Kim BJ. Tumor invasion in the hyponychium is associated with distant metastasis and poor prognosis in subungual melanoma: A histologic landscape of 44 cases. J Am Acad Dermatol 2021; 86:1027-1034. [PMID: 34153394 DOI: 10.1016/j.jaad.2021.06.847] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 06/06/2021] [Accepted: 06/14/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Subungual melanoma (SUM) has a poor prognosis because of delayed diagnosis. Its progression, consensus on surgical treatment, and correlation with clinical outcomes remain unclear. OBJECTIVE We aimed to identify the pattern of dermal invasion in different locations of the nail apparatus and its relationship with prognosis. METHODS In this retrospective review of surgically treated SUM patients between January 2011 and April 2019, the nail apparatus was divided into 5 anatomic subunits: the dorsal roof of proximal nail fold, ventral floor of proximal nail fold, germinal matrix, nail bed, and hyponychium. Invasions in the subunits were categorized using 3 criteria: no tumor, in situ tumor, or invasion. RESULTS Among 44 cases of SUM, dermal invasion occurred mostly in the distal areas, with 11, 30, 18, 7, and 4 in the hyponychium, nail bed, germinal matrix, ventral floor of proximal nail fold, and dorsal roof of proximal nail fold, respectively. The patients with hyponychial invasion showed a significantly greater Breslow depth (P = .009), a higher rate of lymph node metastasis (P = .019), distant metastasis (P = .036), and shorter disease-free survival (P = .001). CONCLUSION Hyponychial invasion is an important prognostic predictor of SUM, given its strong association with invasion depth, metastatic progression, and disease-free survival. Patients with invasion in the hyponychium should undergo more strict workup, treatment, and surveillance.
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Affiliation(s)
- Hyokyung Yoo
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | | | - Sung Tack Kwon
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seong Jin Jo
- Department of Dermatology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Je-Ho Mun
- Department of Dermatology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Cheol Lee
- Department of Pathology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yoonjin Kwak
- Department of Pathology, Seoul National University Hospital, Seoul, Republic of Korea.
| | - Byung Jun Kim
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Rich P, Goldblum O, Disch D, Lin CY, Merola JF, Elewski B. Nail Psoriasis Does Not Affect Skin Response to Ixekizumab in Patients With Moderate-To-Severe Psoriasis. J Drugs Dermatol 2021; 19:741-746. [PMID: 32845588 DOI: 10.36849/jdd.2020.5116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background: Presence of nail psoriasis in patients with plaque psoriasis may be an indicator of greater disease severity. Previously, patients with nail psoriasis have had delayed skin clearance after treatment compared to patients without nail psoriasis. Objective: This post-hoc analysis evaluated the efficacy of ixekizumab in clearance of plaque psoriasis in patients with and without nail psoriasis. Methods: Data were integrated from two phase 3 clinical trials (UNCOVER-2 and UNCOVER-3; N=2570) to assess skin response over 12 weeks of treatment with subcutaneous placebo, etanercept, or ixekizumab in patients with and without nail psoriasis. Nail response was assessed using Nail Psoriasis Severity Index (NAPSI) and skin response was assessed as the percentage of patients achieving 75%, 90%, or 100% improvement in Psoriasis Area and Severity Index (PASI 75, PASI 90, PASI 100) or a score of 0 or 1 on the static Physician Global Assessment (sPGA 0 or 0,1). Results: From baseline to week 12, progressive improvement in psoriasis occurred with ixekizumab and etanercept treatment; however, significantly more patients with nail psoriasis than without mild PASI 75 at weeks 8 and 12 and sPGA (0,1) at week 12 with ixekizumab. Significantly more patients with severe nail psoriasis than mild achieved PASI 75 at weeks 8 and 12 with ixekizumab. Conclusion: Patients with and without nail psoriasis responded well to ixekizumab. The presence of nail psoriasis did not negatively affect skin clearance in patients treated with ixekizumab. ClinicalTrials.gov: NCT01597245, NCT01646177 J Drugs Dermatol. 2020;19(8):741-746. doi:10.36849/JDD.2020.5116.
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Talaga-Ćwiertnia K, Salamon D, Krzyściak P. Unexpected subungual Sarcoptes infestation of toenail - a case report and literature review. Ann Parasitol 2021; 67:779-787. [PMID: 35294148 DOI: 10.17420/ap6704.396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Scabies is the skin infestation caused by Sarcoptes scabiei var hominis. It is one of the commonest dermatological infection which can affect people around the world. However, nails are relatively rarely involved, and the fingernails are mostly infected. The report a case of a 77-year-old woman, long-term pensioner of a nursing home, who had isolated toe subungual Sarcoptes infestation. In addition, the results of systematic review of toenails scabies was presented. Analysis of 21 subungual Sarcoptes infestation cases, revealed that patients in any age (median age 45+/-31.7-year-old) and sex can be affected. Most of the patients had concomitant diseases. Seventy-five percent of cases of nail involvement were treated with combined or sequential therapy. The most used drugs were ivermectin (IVR) and permethrin (PER) (each used in 47.6% cases), following γ-BHC (38.1%) and crotamiton (CRO) (23.8%). It seems that the crucial for adequate diagnosis in scabies affected nails is a precise anamnesis, early and accurate diagnosis that consists of examining not only skin lesions, but including assessing toenails, and differentiation of Sarcoptes infestation from other nail diseases as onychomycosis or psoriasis. Important to achieving a cure is at least frequent nail trimming, softening the nail plate with urea or in the difficult cases the mechanical removal of subungual plaque with using of a scabicide in the location allowing to penatrate it under the nail plate.
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Affiliation(s)
- Katarzyna Talaga-Ćwiertnia
- Chair of Microbiology, Department of Molecular Medical Microbiology, Faculty of Medicine, Jagiellonian University Medical College, ul. Czysta 18, 31-121 Cracow, Poland
- Chair of Microbiology, Department of Infection Control and Mycology, Faculty of Medicine, Jagiellonian University Medical College, ul. Czysta 18, 31-121 Cracow, Poland
| | - Dominika Salamon
- Chair of Microbiology, Department of Infection Control and Mycology, Faculty of Medicine, Jagiellonian University Medical College, ul. Czysta 18, 31-121 Cracow, Poland
| | - Paweł Krzyściak
- Chair of Microbiology, Department of Molecular Medical Microbiology, Faculty of Medicine, Jagiellonian University Medical College, ul. Czysta 18, 31-121 Cracow, Poland
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Parodi M, Errichetti E. Eruptive Mucosal and Ungual Melanoma Metastases. N Engl J Med 2020; 383:169. [PMID: 32640135 DOI: 10.1056/nejmicm1915587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Maria Parodi
- University Hospital Santa Maria della Misericordia, Udine, Italy
| | - Enzo Errichetti
- University Hospital Santa Maria della Misericordia, Udine, Italy
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35
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Abstract
The majority of patients with Sézary syndrome (SS) present with classic symptoms of erythroderma, lymphadenopathy, and pruritus. However, there have been numerous reports of patients with SS who have non-classic signs. In this review, we report the less common clinical presentations of SS and discuss their relevant treatments. Our search included all literature on SS since 2008, the year the World Health Organization (WHO) incorporated the diagnostic criteria for SS into the WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues. We reviewed 896 articles and identified 505 patients with non-classic presentations of SS. Of these 505 patients, the most common non-classic signs of SS were keratoderma, onychodystrophy, alopecia, leonine facies, and ectropion. Given the aggressive and highly symptomatic nature of SS, it is imperative that clinicians recognize the less common signs of the disease to prevent delays in diagnosis and treatment. To our knowledge, this is the first review of the clinical variations of SS with a focus on non-classic signs and symptoms.
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Affiliation(s)
- Lisa Morris
- University of Missouri-Columbia School of Medicine, Columbia, MO, USA
| | - Jessica Tran
- Baylor College of Medicine, Houston, TX, USA.
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. Unit 1452, Houston, TX, 77030, USA.
| | - Madeleine Duvic
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. Unit 1452, Houston, TX, 77030, USA
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Choudhary P, Mehta RD, Ghiya BC, Sharma D. Treatment of nail psoriasis with intramatrical methotrexate: An uncontrolled prospective study of 20 patients. J Am Acad Dermatol 2020; 84:526-528. [PMID: 32380222 DOI: 10.1016/j.jaad.2020.04.159] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 04/18/2020] [Accepted: 04/29/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Paras Choudhary
- Department of Dermatology, Venereology & Leprosy, Sardar Patel Medical College, Bikaner, Rajasthan, India
| | - Rajesh Datt Mehta
- Department of Dermatology, Venereology & Leprosy, Sardar Patel Medical College, Bikaner, Rajasthan, India
| | - Bhikam Chand Ghiya
- Department of Dermatology, Venereology & Leprosy, Sardar Patel Medical College, Bikaner, Rajasthan, India
| | - Divya Sharma
- Department of Dermatology, Venereology & Leprosy, Sardar Patel Medical College, Bikaner, Rajasthan, India.
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Lopez-Castillo D, March-Rodriguez A, Rodriguez-Vida A, Pujol RM, Segura S. Metastatic Calcinosis Cutis Secondary to Selective Fibroblast Growth Factor Receptor Inhibitor: Rapid and Complete Regression after Blood Phosphate Normalization and Drug Withdrawal. Acta Derm Venereol 2020; 100:adv00079. [PMID: 32115665 PMCID: PMC9128941 DOI: 10.2340/00015555-3438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Daniel Lopez-Castillo
- Department of Dermatology, Hospital del Mar-Parc de Salut Mar, ES-08003 Barcelona, Spain.
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LOPEZ-CASTILLO D, CURTO-BARREDO L, SÁNCHEZ-SCHMIDT JM, PUJOL RM. Multiple Eruptive Pyogenic Granulomas on the Proximal Nail Folds Following Cast Immobilization: A Case Report with Nail Unit Ultrasound Findings. Acta Derm Venereol 2020; 100:adv00071. [PMID: 31821515 PMCID: PMC9128891 DOI: 10.2340/00015555-3389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2019] [Indexed: 11/16/2022] Open
Affiliation(s)
- Daniel LOPEZ-CASTILLO
- Department of Dermatology, Hospital del Mar-Parc de Salut Mar, Passeig Marítim, 25-29, ES-08003 Barcelona, Spain. E-mail:
| | - Laia CURTO-BARREDO
- Department of Dermatology, Hospital del Mar-Parc de Salut Mar, Passeig Marítim, 25-29, ES-08003 Barcelona, Spain. E-mail:
| | - Júlia M. SÁNCHEZ-SCHMIDT
- Department of Dermatology, Hospital del Mar-Parc de Salut Mar, Passeig Marítim, 25-29, ES-08003 Barcelona, Spain. E-mail:
| | - Ramon M. PUJOL
- Department of Dermatology, Hospital del Mar-Parc de Salut Mar, Passeig Marítim, 25-29, ES-08003 Barcelona, Spain. E-mail:
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Ishack S, Lipner SR. Evaluating the impact and educational value of YouTube videos on nail biopsy procedures. Cutis 2020; 105:148-E1. [PMID: 32352438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
| | - Shari R Lipner
- Department of Dermatology, Weill Cornell Medicine, New York, USA
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Affiliation(s)
- Yingyuan Yu
- Department of Dermatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine; Institute of Psoriasis, Tongji University School of Medicine, Shanghai, China
| | - Yuling Shi
- Department of Dermatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine; Institute of Psoriasis, Tongji University School of Medicine, Shanghai, China
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41
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Kyriakou G, Gialeli E, Lekkou A, Vryzaki E, Ravazoula P, Georgiou S. Acremonium nail bed mycetoma masquerading as subungual squamous cell carcinoma. Dermatol Online J 2020; 26:13030/qt58m906c3. [PMID: 32155029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 03/02/2020] [Indexed: 06/10/2023] Open
Abstract
Acremonium is a large fungal genus that is comprised of approximately 150 species, found ubiquitously in nature. Although the majority are recognized as being saprophytes in soil and pathogens of plants, several species are emerging as causative agents of a variety of human infections, including mycetomas. Herein, we present a young man that was referred to our department with a painful subungual mass that developed following traumatic inoculation of Acremonium spp. In recent years, the role of Acremonium spp. has been increasingly recognized in localized infections, such as mycetoma, in humans. Other locally invasive as well as disseminated infections are also described. Optimal treatment of Acremonium spp. mycetoma is not well defined owing to the rarity of cases, thus posing a therapeutic challenge.
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Affiliation(s)
- Georgia Kyriakou
- Department of Dermatology, University General Hospital of Patras.
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Priya A, Adil M, Amin SS, Mohtashim M, Bansal R, Alam M. Intralesional Vitamin D3 in Recalcitrant Palmoplantar and Periungual Warts: A Prospective, Observational Study. Acta Dermatovenerol Croat 2019; 27:215-224. [PMID: 31969233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Cutaneous warts are particularly difficult to treat with conventional treatment on sites such as the palms, soles, and periungual region. Immunotherapy boosts the host immune response and helps clear warts with less chance of recurrence. Vitamin D plays an important role in proliferation and differentiation of keratinocytes. The aim of this observational study was to study the efficacy and safety of intralesional vitamin D immunotherapy in the treatment of recalcitrant palmoplantar and periungual warts. Patients who had palmoplantar and periungual warts for more than 6 months and were non-responsive to at least two conventional treatment modalities were selected for the study. A maximum of four warts were injected with 0.2 mL of lignocaine (20 mg/mL), followed by intralesional injection of 0.2-0.5 mL of vitamin D3 (15 mg/mL), every 2 weeks for a maximum of four sessions. Response was assessed based on the reduction in the number of warts. A total of 63 patients were included in the study. The mean number of intralesional vitamin D3 injections required for complete clearance was 3.05±0.83 (mean ± Standard Deviation). Complete response was observed in 56 (88.9%) patients. Maximum clearance was observed in periungual warts (92.9%), followed by palmar warts (90.0%) and plantar warts (86.2%). The most common adverse effect was pain during injection (100.0%) and local swelling (25.4%). Two patients developed recurrence during follow-up. Immunotherapy with vitamin D3 appears to be an effective, inexpensive, and safe treatment in recalcitrant palmoplantar and periungual warts.
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Affiliation(s)
| | - Mohammad Adil
- Assist. Prof. Mohammad Adil, MD, Department of Dermatology, Jawaharlal Nehru Medical College , Aligarh Muslim University, Aligarh, India;
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Plachouri KM, Kolonitsiou F, Georgiou S. Melanonychia Striata: Nail Alterations during Pregnancy. Skinmed 2019; 17:413-414. [PMID: 31904335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
A 35-year-old Greek woman (Fitzpatrick Skin Type IV) presented to our clinic 4 months after the delivery of her first child with nail changes that were first noted during pregnancy. During the 12th week of pregnancy, homogenous dark brown streaks appeared first on the nails of her right second and third fingers (Figure 1a, b) and later on her right fourth toenail (Figure 2a). During the following weeks, she developed similar changes on the second and fourth toenails (Figure 2b). The streaks were uniformly brown, with distinct margins and width of 2-5 mm. There was no pigmentation in the periungual skin (Hutchinson sign) of the affected nails. The direct microscopic examination, cultures, and polymerase chain reaction (PCR) were negative for dermatophytes. The nail changes had not resolved after delivery. Throughout the gestational period, she had developed alveolar hyperpigmentation, but no other changes including the lack of multiple lentigines. During her pregnancy, she had taken calcium supplements from the 8th week until delivery, magnesium and iron supplements throughout pregnancy, as well as progesterone 100 mg daily (Utrogestan®, Besins Healthcare Ltd) from the 8th week through the 12th week. She was otherwise healthy and had no previous pigmentation disorders, chronic diseases, or any other pregnancy complications. There was no family history of pigmentation disorders.
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Affiliation(s)
| | - Fevronia Kolonitsiou
- Department of Microbiology, University General Hospital of Patras, Patras, Greece
| | - Sophia Georgiou
- Department of Dermatology, University General Hospital of Patras, Patras, Greece
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Duarte AA, Carneiro GP, Murari CM, de Jesus LCB. Nail psoriasis treated with intralesional methotrexate infiltration. An Bras Dermatol 2019; 94:491-492. [PMID: 31644634 PMCID: PMC7007033 DOI: 10.1590/abd1806-4841.20198170] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 08/19/2018] [Indexed: 11/22/2022] Open
Affiliation(s)
- Artur Antônio Duarte
- Connective Tissue Disease Unit, Dermatology Service, Universidade de Santo Amaro, São Paulo, SP, Brasil
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Perrin C, Cannata GE, Pedeutour F, Dadone-Montaudié B, Ambrosetti D. Cellular Angiofibroma: Case Report of a Unique Subungual Presentation. Acta Derm Venereol 2019; 99:915-916. [PMID: 30809688 DOI: 10.2340/00015555-3152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Alani A, Blasdale C, Oliphant T, Hackett C, Langtry JAA. The causes of nail apparatus pigmentation presenting to a melanoma screening clinic a prospective study. Clin Exp Dermatol 2019; 44:625-630. [PMID: 30706554 DOI: 10.1111/ced.13897] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Advanced stage primary cutaneous malignant melanoma (PCMM) has a high mortality. PCMM may affect any area of the skin, including the nail apparatus (malignant melanoma or subungual melanoma). Although nail apparatus malignant melanoma (NAMM) is rare, delayed diagnosis carries a poor prognosis. AIM The primary aim was to study the range of nail presentations and identify key patterns to aid in differential diagnosis. A secondary aim was to quantify the number of patients requiring surgery, indications for biopsy, and the incidence and characteristics of NAMM. METHODS This was a prospective study of all referrals with nail apparatus pigmentation to a weekly dedicated melanoma screening clinic over a 6-month period. RESULTS In total, 2246 patients were included. Of the 38 patients referred with nail pigmentation, 1 (2.6%) was diagnosed with NAMM and involved a fungating amelanotic lesion of the right hallux. The remaining patients were diagnosed with subungual haematoma (20/38; 52.6%), viral wart (2/38; 5.4%), acral fibrokeratoma (1/38; 2.6%), myxoid cyst (3/38; 7.9%), fungal nail infection (4/38; 10.5%), Pseudomonas nail infection (1/38; 2.6%), benign linear pigmentation (2/38, 5.3%), Bowen disease (1/38, 2.6%), psoriatic nail changes (2/38; 5.3%) and matrix malalignment (1/38; 2.6%). Of the eight patients (21.1%) who required surgery, five had a biopsy taken and three underwent surgery. Only 14 cases were followed up by Dermatology. NAMM accounted for 0.7% of all melanomas diagnosed. CONCLUSION We illustrate the wide range of diagnoses for pigmented nail presentations and highlight the late presentation of advanced disease in a patient presenting with NAMM.
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Affiliation(s)
- A Alani
- Dermatology Unit, Royal Victoria Infirmary, Newcastle Upon Tyne, UK
| | - C Blasdale
- Dermatology Unit, Royal Victoria Infirmary, Newcastle Upon Tyne, UK
| | - T Oliphant
- Dermatology Unit, Royal Victoria Infirmary, Newcastle Upon Tyne, UK
| | - C Hackett
- Dermatology Unit, Royal Victoria Infirmary, Newcastle Upon Tyne, UK
| | - J A A Langtry
- Dermatology Unit, Royal Victoria Infirmary, Newcastle Upon Tyne, UK
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Trevisan F, Werner B, Pinheiro RL. Nail clipping in onychomycosis and comparison with normal nails and ungual psoriasis. An Bras Dermatol 2019; 94:344-347. [PMID: 31365667 PMCID: PMC6668936 DOI: 10.1590/abd1806-4841.20198301] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 06/04/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Of all nail disorders seen in dermatology offices, half of them are due to onychomycosis. The main differential diagnosis is nail psoriasis. The objective of this study was to compare the microscopic findings, other than the presence of fungi, in the clipping of onychomycosis versus normal nails and nail psoriasis. METHODS Cross-sectional study of onychomycosis cases, analyzed by clipping and compared with data on normal nails and those with nail psoriasis. RESULTS Sixty-two onychomycosis samples were compared with 30 normal nails and 50 nails with psoriasis. In onychomycosis, measurement of subungual region, serous lakes, neutrophils and number of layers of parakeratosis are more intense than in psoriasis. Onychocariosis is less common in psoriasis, while bacteria are more frequent. The nail transition zone is more commonly blurred and irregular in onychomycosis. CONCLUSION Clipping helps in the differential diagnosis of onychomycosis and nail psoriasis and may be useful even when fungi are not found.
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Affiliation(s)
- Flávia Trevisan
- Department of Dermatology, Hospital de Clínicas,
Universidade Federal do Paraná, Curitiba (PR), Brazil
| | - Betina Werner
- Department of Pathology, Hospital de Clínicas, Universidade
Federal do Paraná, Curitiba (PR), Brazil
| | - Rosangela Lameira Pinheiro
- Department of Microbiology and Mycology, Diagnostic Support Unit,
Hospital de Clínicas, Universidade Federal do Paraná, Curitiba (PR),
Brazil
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Zaouak A, Brahim EB, Sassi W, Jouini R, Hammami H, Fenniche S. A Painful Thumb. Skinmed 2019; 17:281-282. [PMID: 31627794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Anissa Zaouak
- Department of Dermatology, Research Unit "Genodermatoses and Cancers LR12SP03," Habib Thameur Hospital, Tunis, Tunisia
| | - Ehsen Ben Brahim
- Department of Anatomopathology, Research Unit "Genodermatoses and Cancers LR12SP03," Habib Thameur Hospital, Tunis, Tunisia
| | - Wiem Sassi
- Department of Dermatology, Research Unit "Genodermatoses and Cancers LR12SP03," Habib Thameur Hospital, Tunis, Tunisia
| | - Raja Jouini
- Department of Anatomopathology, Research Unit "Genodermatoses and Cancers LR12SP03," Habib Thameur Hospital, Tunis, Tunisia
| | - Houda Hammami
- Department of Dermatology, Research Unit "Genodermatoses and Cancers LR12SP03," Habib Thameur Hospital, Tunis, Tunisia
| | - Samy Fenniche
- Department of Dermatology, Research Unit "Genodermatoses and Cancers LR12SP03," Habib Thameur Hospital, Tunis, Tunisia
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49
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50
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John JJ, Lipner SR. Analysis of nail-related content in the basic dermatology curriculum. Cutis 2019; 103:214-216. [PMID: 31116810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Nail conditions are routinely encountered in dermatology clinical practice. Nails have important aesthetic functions, and onychodystrophies may cause pain and difficulties with ambulation and performing activities of daily living. Ideally, accurate diagnosis and optimal treatment of nail disorders are taught as early as medical school and extend into dermatology residency. We sought to determine the integration and content of nail education in the American Academy of Dermatology (AAD) Basic Dermatology Curriculum. Our results showed a paucity of nail content in this medical curriculum with only 101 total mentions of nails in 12 modules. Nail examinations were not mentioned as part of the full-body skin examination, nail unit melanoma was inadequately covered, and nail biopsy techniques were completely omitted. There is a notable need to enrich this curriculum with relevant nail content to educate students about the importance of nail disease.
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Affiliation(s)
- Jason J John
- Virginia Commonwealth University School of Medicine, Richmond, USA
| | - Shari R Lipner
- Department of Dermatology, Weill Cornell Medicine, New York, New York, USA
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