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Aims: The distinction between the benign subungual melanocytic lesions and an early lesion of subungual melanoma (SUM) remains a diagnostic challenge. We evaluated the routine diagnostic utility of array Comparative Genomic Hybridization (aCGH) to detect whole‐genome copy number variations (CNV) as well as targeted next‐generation sequencing (NGS) in SUM. Methods and Results: This retrospective study included 20 cases of in situ SUM and 11 cases of invasive SUM. Analysis by aCGH detected common oncogene amplifications in all but one case of invasive SUM (n = 10) and in all cases of in situ SUM with a melanocyte count (MC) >45/mm (n = 4 true positive) and the average number of CNV was 8.5. Thirteen remaining cases of in situ SUM gave false negative results (n = 13), owing to a lack of sufficient melanocytes to analyse (median MC of 35.35; range: 10.16–39.5). Molecular analysis failed in four cases (three in situ SUM and one invasive SUM) due to insufficient amounts of DNA. Across the whole cohort, the sensitivity of aCGH was 52%, but when adjusting the cutoff to MC >45/mm, the sensitivity was 93%. Targeted NGS was less informative than aCGH analyses in our series of SUM. Conclusion: To distinguish malignant from benign lesions, especially in situ SUM versus atypical lentiginous melanocytic proliferations, aCGH analysis should be performed when the MC is above 45 melanocytes per linear millimetre. This pangenomic method can detect oncogene amplifications, as well as a number of CNV >3, which strongly support the diagnosis of malignancy. [ABSTRACT FROM AUTHOR]

Copyright of Revista ADM is the property of Asociacion Dental Mexicana and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Nearly 10% of all dermatological disorders and conditions are attributed to the disorders of the nails. Onychoscopy is beneficial in the diagnosis of nail conditions as well as for assessment of the progression, severity, and monitoring of the response to the therapy. Aim: The present study aimed to assess the dermoscopic and sociodemographic features in subjects with nail disorders and Onychoscopy of nail lesions in subjects with dermatological disorders. Methods: The present study assessed 88 subjects with nail disorders from both genders. There were 56.81% (n=50) males and 43.18% (n=38) females in the study. In all included subjects, dermoscopic and sociodemographic features were assessed. The data gathered were analyzed for results formulation. Results: The study results showed that fingernails were more commonly affected in 37.5% (n=33) subjects compared to toenails in 84.09% (n=74) subjects. The most common nail condition was Onychomycosis seen in 32.9% (n=29) subjects that showed findings of onycholysis with spikes and jagged edges in 68.9% (n=20), subungual hyperkeratosis in 72.41% (n=21) subjects, and 75.86% (n=22) subjects respectively. The next common condition was nail psoriasis seen in 18.1% (n=16) of study subjects depicting dilated globose nail fold vessels on capillaroscopy, and onycholysis. Conclusions: The present study concludes that onychoscopy can decrease the need for biopsy which is an invasive procedure by focusing on subtle changes and helps in excluding the differential diagnosis. Also, onychoscopy is a diagnostic choice in young children. The present study helped to assess connective tissue disorder severity and can help in diagnosing the benign nature of melanonychia. [ABSTRACT FROM AUTHOR]

This article, published in the Australasian Journal of Dermatology, explores the clinical and dermoscopic features of onychomatricoma in Korean patients. Onychomatricoma is a rare benign tumor that originates from the nail matrix. The study analyzed ten patients with pathologically confirmed onychomatricoma and found that the most common clinical findings were increased nail thickness and xanthonychia. Dermoscopic examination revealed patterns such as localized nail thickening and multiple cavities at the free edge. The study also identified four distinct types of onychomatricoma based on clinical and dermoscopic findings. The article concludes by acknowledging the limitations of the study and the need for further research on the morphologic characteristics of onychomatricoma in different ethnicities. [Extracted from the article]

(1) Purpose: The management of melanonychia is highly controversial. With growing melanonychia, in case of doubt, the entire lesion should be examined. It may appear similar to nail melanoma or may turn into melanoma. Here, we present surgical cases of nail bed total removal and free flap reconstruction. (2) Methods: Between 1 January 2020 and 31 December 2022, eleven patients were operated on for growing melanonychia, involving the hand and foot. After complete resection of the nail root and plate, immediate reconstruction was performed using a fasciocutaneous free flap. The authors describe the procedures in detail with a few illustrations and clinical photographs depicting the techniques. (3) Results: All patients underwent complete nail unit removal around the anatomic boundaries of the nail. Histology showed a nevus and no malignancy in all cases. We used three onychocutaneous flaps, three hypothenar flaps and five venous flaps. All flaps survived, with one case of partial necrosis which spontaneously healed with secondary intention. In the follow-up periods, there was no recurrence or nail regrowth. (4) Conclusions: These free flap techniques are very useful for total nail bed defect reconstruction after melanonychia lesion total ablation. [ABSTRACT FROM AUTHOR]

Resumen: Los signos clínicos que acompañan a muchas alteraciones ungueales habitualmente no son patognomónicos de ninguna enfermedad concreta. Por tanto, la exploración del aparato ungueal desde diferentes ángulos de visión es fundamental para realizar un diagnóstico acertado. En el presente artículo se revisan los signos clínicos que pueden obtenerse mediante la exploración frontal del borde distal de la lámina ungueal y el hiponiquio, y se correlacionan con los signos de la exploración aérea. Dicho abordaje permite facilitar el diagnóstico clínico de la enfermedad ungueal en la práctica diaria. Abstract: Clinical findings in many nail disorders are not usually pathognomonic. An accurate diagnosis therefore relies on inspection of the nail unit from different angles. We review clinical features of different nail disorders that can be observed during frontal examination of the distal edge of the nail plate and the hyponychium and correlate these with features observed when the nail is viewed from above. Frontal examination of the distal nail unit can help establish a clinical diagnosis in routine practice.

Melanonychia is a dark colored pigmented band that is distributed in the nail plate longitudinally, transversely, or totally. This pigmentation might originate from melanocytes of the nail matrix or might be the result of exogenous pigmentation. Onychoscopy and histopathological study are techniques that help us to make the diagnosis in complicated cases. Longitudinal melanonychia is an entity that might present a benign or malignant etiology, which requires the correct physical examination and basic concepts of onychoscopy. It is divided into melanocytic longitudinal melanonychia and nonmelanocytic longitudinal melanonychia. Among the non-melanocytic ones are subungual hematoma and fungal onychopathy. On the other hand, the etiology of melanocytic pigmentation is divided into two: 1) melanocyte activation and 2) melanocyte proliferation. Longitudinal melanonychia is an uncommon onychopathy whose diagnosis is often complicated due to the clinical similarity among related etiologies. Knowing the approach to the mechanisms of nail pigmentation is of utmost importance to diagnose lesions with malignant potential that compromise the patient's life or function. Currently, diagnostic certainty is greater thanks to training in areas such as onychoscopy and its characteristic histopathological findings. [ABSTRACT FROM AUTHOR]

The article discusses a case of Bowen's disease of the nails in two siblings, characterized by longitudinal melanonychia and subungual hyperkeratosis. Both sisters underwent excisional biopsies, which revealed atypical keratinocytes with dyskeratosis, leading to a diagnosis of Bowen's disease. Polymerase chain reaction (PCR) testing detected the same human papillomavirus (HPV) type 56 in both cases, suggesting a possible vertical transmission or frequent contact as the mode of transmission. This study sheds light on the significance of further research into the underlying causes and mechanisms of nail Bowen's disease. [Extracted from the article]

Although there is a higher incidence of melanoma among non-Hispanic White individuals, melanoma is diagnosed at more advanced stages and associated with worse survival rates among individuals with skin of color (SOC). The proportions of melanoma subtypes differ across racial groups, with acral lentiginous melanoma and mucosal melanoma representing higher proportions of melanoma diagnoses in individuals with SOC compared to White individuals. The recognition of distinct differences in anatomic locations and dermatoscopic patterns may facilitate the appropriate differentiation of physiologic from pathologic pigmentation. The first article of this continuing medical education series will focus on the epidemiology and clinical presentation of melanoma in individuals with SOC, with the aim of improving early diagnoses and clinical outcomes. [ABSTRACT FROM AUTHOR]

Copyright of Revista ADM is the property of Asociacion Dental Mexicana and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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. [ABSTRACT FROM AUTHOR]

Melanonychia striata longitudinalis might involve one or more fingers and/or toes and might result from several different causes, including benign and malignant tumors, trauma, infections, and acti-vation of melanocytes that might be reactive or related to the pigmentary trait,drugs and some rare syndromes.This broad differential diagnosis renders the clinical assessment of melanonychia striata particularly challenging. Nail matrix melanoma is relatively rare, occurs almost always in adults in-volves more frequently the first toe or thumb.The most common nail unit cancer,squamous cell carcinoma / Bowen disease (SCC) of the nail matrix is seldom pigmented. Histopathologic examina-tion remains the gold standard for melanoma and SCC diagnosis,but excisional or partial biopsies from the nail matrix require training and is not routinely performed by the majority of clinicians.Furthermore, the histopathologic evaluation of melanocytic lesions of the nail matrix is particularly challenging, since early melanoma has only bland histopathologic alterations. Dermatoscopy of the nail plate and its free edge significantly improves the clinical diagnosis, since specific patterns have been associated to each one of the causes of melanonychia. Based on knowledge generated and pub-lished in the last decades, we propose herein a stepwise diagnostic approach for melanonychia striata longitudinalis: 1) Hemorrhage first 2) Age matters 3) Number of nails matters 4) Free edge matters 5) Brown or gray? 6) Size matters 7) Regular or irregular and, finally,“follow back”.

Pigmented lesions in acral areas are very frequent in our population. Acral lentiginous melanoma in our environment is usually diagnosed in advanced stages. Therefore, the importance of proper dermoscopy and histopathological correlation in suspicious lesions is essential. We present the case of a patient with longitudinal melanonychia in the first finger of the right hand with dermoscopic follow-up. [ABSTRACT FROM AUTHOR]

Background: Problematic nails and toenails are infected by germs and increasingly have many causes. Aims: To investigate the types and treatment of problematic nails and toenails, we focused on bacteria that may appear in problematic nail toenail symptoms. Methods: We have searched for PubMed and Google Scholar and correlated the words Onychomycosis, Tinea ungium, Melanonychia, and ingrown toenail related to symptoms. Results: To measure onychomycosis, KOH tests and fungal culture tests will be used. Treatment can be treated with full‐body treatment using anti‐fungal agents and local treatment (laser therapy) that can minimize the side effects. A biopsy should be performed when Melanonychia is diagnosed with brown or black pigments on the patient's fingernail plate. Moreover, ingrown toenail surgical treatment can be improved by acquired lifestyle. Conclusions: There are many different types of treatments, but many studies show that problematic nail and toenail improvement periods are long and treatment success rates are low. [ABSTRACT FROM AUTHOR]

Shiyu Jiang, Jixiang Xu, Xia Xiong, Yongqiong Deng Department of Dermatology & STD, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People’s Republic of ChinaCorrespondence: Yongqiong DengDepartment of Dermatology & STD, The Affiliated Hospital of Southwest Medical University, No. 25, Taiping Street, Luzhou, 646000, Sichuan Province, People’s Republic of ChinaTel +86-13679670608Fax +86-8303165651Email dengyongqiong1@126.comAbstract: The common causes for melanonychia include melanoma, repetitive trauma, underlying systemic diseases, onychomycosis, pseudomonas infection and drugs. Drug-induced melanonychia usually affects numerous nails and appears as light brown to black pigmentation on the deck or nail bed with longitudinal, transverse or diffuse distribution. In previous cases, a number of chemotherapeutic agents such as azathioprine, bleomycin sulfate, cyclophosphamide, hydroxyurea and methotrexate were usually linked to melanonychia. Citri reticulatae pericarpium (CRP) is a traditional Chinese herb which is widely used in many foods and health care products in China. Up till now, there were no adverse reactions of CRP reported throughout the literature. Herein, we firstly reported a case of melanonychia in a 67-year-old man caused by CRP for external use.Keywords: traditional Chinese herb, citri reticulatae pericarpium, melanonychia

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 observed. 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 disappear completely. The age of onset, sex, finger/toe position, Hutchinson's sign, and nail dystrophy were not associated with complete regression. During follow-up, most cases demonstrated no change in color or width between the first and last visit, and early darkening/widening before stabilization or lightening/narrowing was common. The lightning of pigmentation was associated with complete regression, whereas change in width was not.Limitations: Retrospective study at a tertiary center.Conclusion: Our results suggest that clinicians ought to follow pediatric patients with 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. [ABSTRACT FROM AUTHOR]

Employed in the treatment of malignancies and non-neoplastic conditions, hydroxyurea is associated with integumentary adverse effects, including skin discoloration, xerosis, pruritus, cutaneous atrophy, chronic leg ulcers, oral ulcerations, alopecia, and some nail abnormalities.A 77-year-old woman was diagnosed with essential thrombocytosis and started on low dose hydroxyurea. After 20 weeks of treatment, she experienced an unexpected change in hair color from gray to dark brown, without using hair dye or supplements. She later developed bilateral dorsal hand melanoderma, melanonychia, and onychodystrophy.It was decided to monitor the patient with no action taken as she was happy with this side effect of hydroxyurea. The platelet count has remained in excellent control. The dark brown hair color persisted over time.Hair hyperpigmentation likely occurred through melanocyte activation via hydroxyurea. Severe side effects may require dosage adjustments, while milder effects can be monitored closely. The newly observed hair color restoration in this case highlights potential dual (therapeutic and aesthetic) applications of this class of agents. [ABSTRACT FROM AUTHOR]

Copyright of Acta Facultatis Medicae Naissensis is the property of Nis University, Faculty of Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Salient nail unit changes serve as pointers toward systemic disease. On similar lines, salient nail changes are associated with pigmentary disorders, and can help toward diagnosis. Nail changes form a part of various physiologic pigmentary changes including racial pigmentation, pregnancy, or neonatal period. At the same time, a number of nail changes can be valuable clues toward disorders of pigmentation associated with genetic syndromes (Laugier–Hunziker syndrome, incontinentia pigmenti, and tuberous sclerosis), endocrine disorders, disorders of metabolism (alkaptonuria), infections (HIV-AIDS), internal malignancies, etc. Nail changes are especially useful if cutaneous pigmentary changes are suspected to be drug-induced based or associated mucosal and/or cutaneous hyperpigmentation. Various drugs that can cause cutaneous pigmentary alterations along with nail changes include cyclophosphamide, adriamycin, vincristine, docetaxel, paclitaxel, carboplatin, psoralens, hydroxyurea, bleomycin, etc. Nail changes are also associated with disorders of hypomelanosis, for example, vitiligo. Pigmentary changes due to endogenous and exogenous pigments are again diagnosable based on the nail changes they induce. This narrative review highlights the importance of nail changes in suspecting and diagnosing various disorders of pigmentation. It also points toward areas which need future research.

Background: Previous studies reported that cellular remnants in the nail plate could be a diagnostic clue for subungual melanoma (SUM). We sought to characterize the histopathologic features of cellular remnants in the nail plates of SUM patients. Methods: A retrospective case‐control study was conducted in a single tertiary center from 2012 to 2019. Twenty‐three patients with pathologically diagnosed SUM and eight nail matrix nevi (NMN) patients were recruited. The analysis of the nail plate specimens focused on large cellular remnants of melanocytes (LCRMs). Longitudinal linear density and vertical distribution pattern of the LCRMs were scrutinized for possible features distinguishing SUM from NMN. Results: The median linear density of the LCRMs was significantly higher in the SUM samples than in the NMN samples. LCRMs in the SUM samples were more dorsally distributed than those in the NMN samples. In invasive SUM, LCRMs were more likely to be found in the dorsal part of the nail plate compared to SUM in situ. Conclusion: Nail plate specimens should not be overlooked in the histopathological examination of melanonychia. High‐density LCRMs with more dispersion to the dorsal side might be suggestive of SUM. [ABSTRACT FROM AUTHOR]

Background: Onychopapilloma is a benign tumor of the distal nail matrix and proximal nail bed with heterogeneous clinical presentations. It poses a diagnostic challenge because it could mimic subungual malignancies and inflammatory conditions. Clinical, onychoscopic, and histopathological clues play critical roles in diagnosis. Methods: We performed a retrospective chart review of onychopapilloma cases collected over 10 years, and characterized the clinical, onychoscopic, and histopathological features of onychopapilloma at an academic institution. Results: We obtained 17 biopsy‐confirmed cases of onychopapilloma. Among our cases, we found manifestation of onychopapilloma as longitudinal erythronychia, longitudinal leukonychia, yellow‐brown chromonychia, and longitudinal melanonychia. Long longitudinal or short splinter hemorrhages may be present. Distal fissuring with V‐shaped notch, subungual keratotic mass, and onycholysis are other discernable features. Histopathological features include papillomatosis, epidermal hyperplasia, acanthosis of the distal nail bed, premature keratinization, matrix metaplasia, hyperkeratosis, and splinter hemorrhages; histopathological signs of malignancy were not observed in any of our cases. Conclusions: Onychopapilloma has polymorphic clinical and morphological features. Onychoscopic and histopathological studies are important to help exclude malignant mimickers. Consider onychopapilloma in the differential diagnoses of a monodactylous longitudinal streak in the nail, especially on the left thumb of an adult female. [ABSTRACT FROM AUTHOR]

Copyright of Forum Dermatologicum is the property of VM Medica-VM Group (Via Medica) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Nail pigmentation in children can cause significant anxiety in parents and clinicians. Different pigments of the nails, such as yellow, orange, and green, can all occur; however, this paper will focus on the dark pigments: brown, gray, and black pigmentation of the nails. Many causes of dark coloration of the nails exist; almost all causes in pediatric patients are benign and require no treatment. Melanoma is the one diagnosis that physicians do not want to miss. Fortunately, this is extremely rare in children. [ABSTRACT FROM AUTHOR]

Background: The nail changes caused by chemotherapy in cancer patients are difficult to assess and often overlooked by clinician. The present study was undertaken to study nail changes caused by various chemotherapeutic agents and various drug protocols most commonly associated with them. Materials and Method: Five hundred patients with malignancies receiving chemotherapy in the oncology ward and skin outpatient department were screened in this cross-sectional observational study from November 2018 to October 2019. Results: Nail changes due to chemotherapy were observed in 37.6% patients. The most common condition observed was melanonychia (84.04%), followed by half and half nails (6.91%), erythronychia (5.31%), longitudinal grooves (2.12%), leukonychia (2.12%), Mees’ lines (1.59%), Beau's lines (0.53%), pitting (0.53%), and subungual hyperkeratosis (0.53%). The usual protocol to cause melanonychia was platinum analogues + taxanes based combinations, half and half nails by platinum analogues + taxanes + 5 fluorouracil (5FU) based polypharmacy, and erythronychia by cisplatin-based adjuvants. Conclusion: The knowledge of the nail changes caused by chemotherapy will help in counseling of already worried patients with malignancy. It will also improve patient compliance and enrich the clinicians’ knowledge pertaining to chemotherapy-induced nail changes.

Background: Anticancer chemotherapy is associated with multisystem adverse effects. Chemotherapy can affect skin, nails, and hair and may sometimes affect the quality of life to the point of requiring discontinuation of therapy. There are many new chemotherapeutic agents, and with that, a rise in the adverse effects attributed to them. Purpose: To evaluate the frequency of nail changes occurring due to anticancer therapy. Methods: We screened 100 cancer patients admitted in the oncology ward of a tertiary care center in South India from July to September 2017. The nail changes were documented and analyzed with emphasis on developing a relationship if any with a chemotherapeutic agent. Results: Nail changes were observed in 62 (62%) cases. Breast carcinoma (20 cases) was the most common malignancy. Doxorubicin (36 cases) and cyclophosphamide (27 cases) were the most common chemotherapeutic drugs associated with nail changes. Pigmentary changes (32 cases) were the most common nail plate changes. Blue lunula (24 cases) was the most common nail bed change, occurring with cyclophosphamide/doxorubicin. Pyogenic granuloma was the only nail fold change that was noted in a patient of carcinoma of breast treated with gefitinib. Conclusion: Cancer chemotherapy may be associated with a variety of nail changes. Addressing nail changes may have the potential to improve cancer treatment patients' quality of life.

ABSTRACT INTRODUCTIONSubungual haemorrhage describes blood located between the nail matrix and nail plate caused by trauma. Lack of recalled trauma and long duration of nail pigmentation results in specialist referrals to rule out malignant pathology. AIMThis report aims to describe the macroscopic and dermoscopic characteristics of subungual haemorrhage and to highlight its clinical differentiation from melanocytic lesions. METHODSNinety-eight nails were assessed. Pigmentation in fifty-nine was due to subungual haemorrhage and was melanocytic in the remainder (identified by a longitudinal pigmented band). RESULTSPigmentation in subungual haemorrhage had a clear proximal margin (73%) and the dermoscopic pattern was homogenous (97%), globular (78%) or streaky (34%). Features included peripheral fading (68%) and periungual haemorrhage (5%). Malignancy could be excluded in these cases by careful clinical evaluation. DISCUSSIONA combination of macroscopic and dermoscopic characteristics help make a confident diagnosis of subungual haemorrhage. A two-stage process can aid clinical diagnosis by looking for known features of subungual haemorrhage and identifying absence of malignant features.

Onychocytic matricoma (OCM) is a benign epithelial acanthoma derived from the nail matrix. It is a rare and relatively new disease of the nail first described in 2012, with only 14 cases published in English literature so far. Here, we reported the first two cases of OCM in Taiwan, presenting as longitudinal streaks of nail thickening with yellowish-white discoloration and various amount of splinter hemorrhages. A brief introduction of the pathological characteristics of various subtypes and clinical differential diagnoses were provided through literature review. OCM should be included among the differential diagnoses of longitudinal pachymelanonychia or xantholeucopachyonychia.

Melanonychia is a very worrisome entity for most patients. It is characterized by brownish black discoloration of nail plate and is a common cause of nail plate pigmentation. The aetiology of melanonychia ranges from more common benign causes to less common invasive and in situ melanomas. Melanonychia especially in a longitudinal band form can be due to both local and systemic causes. An understanding of the epidemiology, pathophysiology and clinical details is necessary for adequate patient care and counseling. It not only helps in the early recognition of melanoma but also prevents unnecessary invasive work up in cases with benign etiology. An early diagnosis of malignant lesion is the key to favourable outcome. Though there are no established guidelines or algorithms for evaluating melanonychia, a systematic stepwise approach has been suggested to arrive at a probable etiology. We, hereby, review the aetiology, clinical features, diagnostic modalities and management protocol for melanonychia.

Hydroxyurea (HU) is an antimetabolite agent. It is commonly used in the treatment of various hematologic disorders. I described a case of multiple melanonychia during HU therapy. [ABSTRACT FROM AUTHOR]

Introduction: Longitudinal melanonychia presents with pigmented longitudinal streaks of the nail plate. It results from an increased activity of melanocytes or melanocytic hyperplasia in the nail matrix or nail bed and is associated with increased melanin deposition in the nail plate. Distal onycholysis is characterized by separation of the distal part of the nail plate from the nail bed. Objective: To present a case of longitudinal melanonychia and distal onycholysis associated with 5-fluorouracil/adriamycin/cyclophosphamide chemotherapy. Case report: A 66-year-old woman, who received 5-fluorouracil/adriamycin/cyclophosphamide for breast cancer developed longitudinal melanonychia and distal onycholysis. After discontinuation of chemotherapy, nail changes improved significantly. Conclusions: Drug-induced longitudinal melanonychia and distal onycholysis are common adverse effects of breast cancer chemotherapy. This case shows that lesions may resolve after discontinuation of therapy. [ABSTRACT FROM AUTHOR]

Salient nail unit changes serve as pointers toward systemic disease. On similar lines, salient nail changes are associated with pigmentary disorders, and can help toward diagnosis. Nail changes form a part of various physiologic pigmentary changes including racial pigmentation, pregnancy, or neonatal period. At the same time, a number of nail changes can be valuable clues toward disorders of pigmentation associated with genetic syndromes (Laugier–Hunziker syndrome, incontinentia pigmenti, and tuberous sclerosis), endocrine disorders, disorders of metabolism (alkaptonuria), infections (HIV-AIDS), internal malignancies, etc. Nail changes are especially useful if cutaneous pigmentary changes are suspected to be drug-induced based or associated mucosal and/or cutaneous hyperpigmentation. Various drugs that can cause cutaneous pigmentary alterations along with nail changes include cyclophosphamide, adriamycin, vincristine, docetaxel, paclitaxel, carboplatin, psoralens, hydroxyurea, bleomycin, etc. Nail changes are also associated with disorders of hypomelanosis, for example, vitiligo. Pigmentary changes due to endogenous and exogenous pigments are again diagnosable based on the nail changes they induce. This narrative review highlights the importance of nail changes in suspecting and diagnosing various disorders of pigmentation. It also points toward areas which need future research. [ABSTRACT FROM AUTHOR]

A paediatric nail consultation is often required to reduce parents’ concerns regarding their child’s abnormal nail appearance. Nail pigmentation in children is a dermatological challenge because guidelines are not standardised, causing many doubts for dermatologists. In general, the majority of cases of melanonychia are benign in children and nail melanoma cases are very rare. However, alarming clinical and dermoscopic features can be observed, requiring nail surgery to confirm a diagnosis. Here, we present a case of longitudinal melanonychia in a teenager with atypical signs and a good prognosis.

INTRODUCTION: Subungual haemorrhage describes blood located between the nail matrix and nail plate caused by trauma. Lack of recalled trauma and long duration of nail pigmentation results in specialist referrals to rule out malignant pathology. AIM: This report aims to describe the macroscopic and dermoscopic characteristics of subungual haemorrhage and to highlight its clinical differentiation from melanocytic lesions. METHODS: Ninety-eight nails were assessed. Pigmentation in fifty-nine was due to subungual haemorrhage and was melanocytic in the remainder (identified by a longitudinal pigmented band). RESULTS: Pigmentation in subungual haemorrhage had a clear proximal margin (73%) and the dermoscopic pattern was homogenous (97%), globular (78%) or streaky (34%). Features included peripheral fading (68%) and periungual haemorrhage (5%). Malignancy could be excluded in these cases by careful clinical evaluation. DISCUSSION: A combination of macroscopic and dermoscopic characteristics help make a confident diagnosis of subungual haemorrhage. A two-stage process can aid clinical diagnosis by looking for known features of subungual haemorrhage and identifying absence of malignant features. [ABSTRACT FROM AUTHOR]

Background: The nail changes caused by chemotherapy in cancer patients are difficult to assess and often overlooked by clinician. The present study was undertaken to study nail changes caused by various chemotherapeutic agents and various drug protocols most commonly associated with them. Materials and Method: Five hundred patients with malignancies receiving chemotherapy in the oncology ward and skin outpatient department were screened in this cross-sectional observational study from November 2018 to October 2019. Results: Nail changes due to chemotherapy were observed in 37.6% patients. The most common condition observed was melanonychia (84.04%), followed by half and half nails (6.91%), erythronychia (5.31%), longitudinal grooves (2.12%), leukonychia (2.12%), Mees' lines (1.59%), Beau's lines (0.53%), pitting (0.53%), and subungual hyperkeratosis (0.53%). The usual protocol to cause melanonychia was platinum analogues + taxanes based combinations, half and half nails by platinum analogues + taxanes + 5 fluorouracil (5FU) based polypharmacy, and erythronychia by cisplatin-based adjuvants. Conclusion: The knowledge of the nail changes caused by chemotherapy will help in counseling of already worried patients with malignancy. It will also improve patient compliance and enrich the clinicians' knowledge pertaining to chemotherapy-induced nail changes. [ABSTRACT FROM AUTHOR]

Onychoscopy is the examination of the nail unit using a dermoscope. Although many details of nail diseases can be evaluated with the naked eye, dermoscopy serves as a second microscope for nail changes during routine evaluation in some diseases wich present a diagnostic challenge for dermatologists in daily practice. In recent years, the effectiveness of onychoscopy has been increasing in order to facilitate clinical evaluation of nail diseases, to avoiding from invasive procedures such as culture, biopsy, and also saving time for diagnosis and treatment. This review also aims to summarize the available information on the onychoscopic features of various diseases in the nail unit and to provide practical tips on how to perform the onychoscopy. [ABSTRACT FROM AUTHOR]

Melanonychia refers to a black-brown-grey pigmentation of the nail plate. It is caused by the presence of melanin and commonly appears as a longitudinal band (longitudinal melanonychia). Differential diagnosis encompasses benign and malignant conditions. Nail dermatoscopy (onychoscopy) is a reliable diagnostic tool that provides useful information about nail pigmentations. In this article, the causes, clinical and dermatoscopic features of melanonychia have been reviewed through an algorithm. [ABSTRACT FROM AUTHOR]

Introduction: There are very few studies about dermoscopic findings of fungal melanonychia (FM) apart from the case reports. Aim: To reveal and identify dermoscopic findings which facilitate diagnosis of the FM. Material and methods: The study included a total of 42 nails from 33 patients diagnosed with FM on the basis of the clinical history, physical examination, dermoscopic findings and microbiological investigation. All of the dermoscopic images were retrospectively reviewed and the findings identified were recorded in a period of 1 year. Results: The most common presentation was homogenous brown pigmentation (n = 15, 35.7%). The other presentations included: homogenous black (n = 9, 21.4%), homogenous grey (n = 9, 21.4%), clumped/granular black (n = 7, 16.6%) and irregular longitudinal black (n = 4, 9.5%) pigmentation. Superficial transverse striation was observed in 11 (26.1%) nails. Twenty (47.6%) nails showed white streaks (white longitudinal striae) and 6 (14.2%) nails showed distal white jagged edge (also known as "spikes"). Twenty-two (52.3%) nails had at least one of white streaks and jagged edge findings. 4 (9.5%) nails showed pseudo Hutchinson's sign. Conclusions: To the best of our knowledge, this is the most comprehensive study regarding the dermoscopic patterns of FM. Here, we also evaluated onychomycosis associated dermoscopic findings like white longitudinal striae and jagged edges. Our study, along with the previous studies, showed that dermoscopy can be a very helpful method in the diagnosis of FM. Long disease duration, homogenous pigmentation pattern, presence of white streaks and jagged edges are the main clues to FM. [ABSTRACT FROM AUTHOR]

We recently treated a patient who presented with a hyperpigmented longitudinal stripe of the thumb nailbed which was biopsied with a histopathologic diagnosis of onychopapilloma. We have not seen onychopapilloma reported in the hand surgery literature. Onychopapilloma is generally benign but a malignant variant has recently been reported. [ABSTRACT FROM AUTHOR]

Abnormal colouring of the nails may be a sign of underlying systemic or local disorders. This study investigated the prevalence and causes of chromonychia as a whole, as well as of each subtype. Among 163 patients with chromonychia, trauma was the pathogenesis in up to 20.9% (34/163) of cases. The most common subtype was melanonychia (54.0%; 88/163), followed by leukonychia (23.9%), red (8.6%), green (6.7%), yellow (4.9%) and blue (1.8%) nails. Nail matrix naevus (33.3%; 29/88) was the most common cause of melanonychia, while skin diseases (41.0%; 16/39), such as psoriasis (75%, 12/16) and alopecia areata (18.8%; 3/16), in addition to systemic diseases (33.3%; 13/39) including anaemia (38.5%, 5/13) and chronic renal failure (15.4%; 2/13) were the dominant causes of leukonychia. As chromonychia may be the first or only sign of an underlying disorder, it should alert physicians and patients to the need for a prompt and thorough evaluation.

Melanonychia is a very worrisome entity for most patients. It is characterized by brownish black discoloration of nail plate and is a common cause of nail plate pigmentation. The aetiology of melanonychia ranges from more common benign causes to less common invasive and in situ melanomas. Melanonychia especially in a longitudinal band form can be due to both local and systemic causes. An understanding of the epidemiology, pathophysiology and clinical details is necessary for adequate patient care and counseling. It not only helps in the early recognition of melanoma but also prevents unnecessary invasive work up in cases with benign etiology. An early diagnosis of malignant lesion is the key to favourable outcome. Though there are no established guidelines or algorithms for evaluating melanonychia, a systematic stepwise approach has been suggested to arrive at a probable etiology. We, hereby, review the aetiology, clinical features, diagnostic modalities and management protocol for melanonychia. [ABSTRACT FROM AUTHOR]