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Perrin C, Coutts M, Dadone-Montaudié B. Subungual melanoma: molecular analysis of 31 cases from early stage to invasive melanoma. Histopathology 2024. [PMID: 39138795 DOI: 10.1111/his.15297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 07/08/2024] [Accepted: 07/20/2024] [Indexed: 08/15/2024]
Abstract
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.
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Affiliation(s)
- Christophe Perrin
- Laboratoire Central d'Anatomie Pathologique, Nice University Hospital, Nice, France
| | - Michael Coutts
- Department of Cellular Pathology, Maidstone Hospital, Kent, UK
| | - Bérengère Dadone-Montaudié
- Institute for Research on Cancer and Aging of Nice (IRCAN) CNRS UMR 7284/INSERM U1081, University of Cote d'Azur (UCA), Nice University Hospital, Nice, France
- Department of Pathology and Molecular Oncology, Laboratoire d'Oncologie Moléculaire, Nice University Hospital, Nice, France
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Tsai SYC, Hamilton CE, Mologousis MA, Hawryluk EB. Melanoma-like features in pediatric longitudinal melanonychia: A systematic review and meta-analysis. Pediatr Dermatol 2024; 41:613-620. [PMID: 38500311 DOI: 10.1111/pde.15597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 02/27/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND Pediatric longitudinal melanonychia (LM) can exhibit atypical features that mimic red-flag signs for subungual melanoma in adults and lead to diagnostic uncertainty. Nail biopsy may be unnecessary if clinical inspection and dermoscopy suggest a benign nature. METHODS We searched PubMed and Embase from inception to February 2023 for studies of any design reporting either the number or proportion of clinical and dermoscopic features in at least five children (≤18 years) with LM. Non-English articles, reviews, and abstracts were excluded. We performed a systematic review and meta-analysis to collate all existing data. RESULTS A total of 1218 articles were screened and 24 studies with 1391 pediatric patients were included. Nevus was the most common diagnosis (86.3%). The most prevalent sites were fingernails (76.2%) and first digits (45.4%). Pooled proportions of common features were: dark-color bands (69.8%), multi-colored bands (47.6%), broad bandwidth (41.1%), pseudo-Hutchinson sign (41.0%), irregular patterns (38.1%), Hutchinson sign (23.7%), dots and globules (22.5%), nail dystrophy (18.2%), and triangular sign (10.9%). Outcomes included progression (widening or darkening, 29.9%), stability (23.3%), and spontaneous regression (narrowing or fading, 19.9%). Only eight cases of subungual melanoma in situ were reported, and no invasive melanomas were identified. CONCLUSION Although atypical characteristics are common in pediatric LM, the probability of malignant transformation is exceedingly low. Appropriate evaluation and management of pediatric LM includes careful clinical and dermoscopic inspection with attention to benign features followed by long-term interval follow-up.
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Affiliation(s)
- Serena Yun-Chen Tsai
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Claire E Hamilton
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Mia A Mologousis
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Elena B Hawryluk
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Ani O, Xu W, Chang B, Lin IC. Clinical and Histopathological Investigation of Pediatric Melanonychia: A Single-Center Retrospective Case Series. Ann Plast Surg 2024; 92:S87-S90. [PMID: 38556653 DOI: 10.1097/sap.0000000000003865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
HYPOTHESIS The natural history of pediatric melanonychia and the necessity of biopsy for ruling out melanoma are debated in the literature. We hypothesize that there is a low rate of malignant nail pathology among pediatric patients undergoing nail bed biopsy for melanonychia. METHODS We performed a retrospective chart review of 54 pediatric patients (age <18 years) at a single institution who presented with melanonychia and underwent nail bed biopsy from 2007 to 2022. Data points collected included patient demographics, medical history, physical exam findings, pathology reports, and clinical photos. Univariate and multivariate analyses were performed to assess for risk factors associated with high-risk pathology findings. RESULTS The average age of melanonychia onset was 5.5 years (SD 4.4). The average age of first biopsy was 7.8 years (SD 4.3). On physical exam, 27 patients had at least four features concerning for melanoma (asymmetry, border irregularity, color heterogeneity, diameter > 1/3 of nail, evolving color, evolving diameter, Hutchinson's sign). The most common pathology diagnoses were melanocytic nevus (35%), atypical intraepidermal melanocytic proliferation (AIMP) with benign features (24%), subungual lentigo (22%), and AIMP with concerning features (17%). There were no cases of melanoma in situ or invasive malignant melanoma. On multivariate regression, the only significant risk factor associated with more concerning pathology (AIMP with concerning features) was the calendar year in which biopsy was performed (coefficient = -0.34, P = 0.016). There was no association between physical exam features and high-risk pathology. Twelve patients had surgical re-excision of the lesion, 6 of which were due to incomplete excision of AIMP with concerning features and 6 of which were due to recurrence. CONCLUSIONS Our case series did not find any cases of melanoma in situ or malignant melanoma arising from pediatric melanonychia. Atypical intraepidermal melanocytic proliferation with concerning features was associated only with the year in which the biopsy was performed, which may reflect the improved understanding of pediatric melanonychia as often benign despite concerning features on pathology. The decision to perform a nail matrix biopsy in pediatric melanonychia should be based on a collaborative discussion between the patient's parents, dermatologist, and plastic surgeon.
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Affiliation(s)
- Omar Ani
- From the Perelman School of Medicine at the University of Pennsylvania
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Usui-Taniguchi M, Kaji T, Taniguchi K, Kawakami Y, Morizane S, Toi Y. A pediatric case of gradually spreading longitudinal melanonychia initially accompanied by Hutchinson's sign. J Dermatol 2023; 50:e297-e298. [PMID: 37122178 DOI: 10.1111/1346-8138.16805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/24/2023] [Accepted: 03/31/2023] [Indexed: 05/02/2023]
Affiliation(s)
- Mana Usui-Taniguchi
- Department of Dermatology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Tatsuya Kaji
- Department of Dermatology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Kohei Taniguchi
- Department of Pathology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Yoshio Kawakami
- Department of Dermatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Shin Morizane
- Department of Dermatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Yoichiro Toi
- Department of Dermatology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
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Conway J, Bellet JS, Rubin AI, Lipner SR. Adult and Pediatric Nail Unit Melanoma: Epidemiology, Diagnosis, and Treatment. Cells 2023; 12:cells12060964. [PMID: 36980308 PMCID: PMC10047828 DOI: 10.3390/cells12060964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/16/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
Nail unit melanoma (NUM) is an uncommon form of melanoma and is often diagnosed at later stages. Approximately two-thirds of NUMs are present clinically as longitudinal melanonychia, but longitudinal melanonychia has a broad differential diagnosis. Clinical examination and dermoscopy are valuable for identifying nail findings concerning malignancy, but a biopsy with histopathology is necessary to confirm a diagnosis of NUM. Surgical treatment options for NUM include en bloc excision, digit amputation, and Mohs micrographic surgery. Newer treatments for advanced NUM include targeted and immune systemic therapies. NUM in pediatric patients is extremely rare and diagnosis is challenging since both qualitative and quantitative parameters have only been studied in adults. There is currently no consensus on management in children; for less concerning melanonychia, some physicians recommend close follow-up. However, some dermatologists argue that the "wait and see" approach can cause delayed diagnosis. This article serves to enhance the familiarity of NUM by highlighting its etiology, clinical presentations, diagnosis, and treatment options in both adults and children.
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Affiliation(s)
- Jade Conway
- School of Medicine, New York Medical College, Valhalla, NY 10595, USA
| | - Jane S Bellet
- Department of Dermatology and Pediatrics, Duke University School of Medicine, Durham, NC 27710, USA
| | - Adam I Rubin
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
- Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
- Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Shari R Lipner
- Department of Dermatology, Weill Cornell Medicine, New York, NY 10021, USA
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Lee J, Bae JH, Oh SJ, Lee D, Kim HJ, Kim IH, Mun JH, Kim KH, Lee KH. Clinical and histopathologic features of pediatric longitudinal melanonychia: A multicenter retrospective study. J Am Acad Dermatol 2023:S0190-9622(23)00272-4. [PMID: 36841337 DOI: 10.1016/j.jaad.2023.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 01/12/2023] [Accepted: 02/09/2023] [Indexed: 02/27/2023]
Affiliation(s)
- Jongeun Lee
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jai Hee Bae
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Se Jin Oh
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dongyoun Lee
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Hee Joo Kim
- Department of Dermatology, Gil Medical Center, School of Medicine, Gachon University College of Medicine, Incheon, Korea
| | - Il-Hwan Kim
- Department of Dermatology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Je-Ho Mun
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
| | - Kwang Ho Kim
- Department of Dermatology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Kyung Ho Lee
- Department of Dermatology, Bucheon St Mary's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
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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: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [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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Park S, Yun SJ. Acral Melanocytic Neoplasms: A Comprehensive Review of Acral Nevus and Acral Melanoma in Asian Perspective. Dermatopathology (Basel) 2022; 9:292-303. [PMID: 35997352 PMCID: PMC9397077 DOI: 10.3390/dermatopathology9030035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 08/12/2022] [Accepted: 08/15/2022] [Indexed: 11/16/2022] Open
Abstract
Acral melanocytic neoplasms, including acral melanocytic nevus and acral melanoma, are common melanocytic lesions in Asian populations. Both lesions occur on the volar surface of the hands and feet, and on nail units. Acral melanocytic nevi occur on the arch area of the sole, whereas acral melanomas frequently occur on weight-bearing areas of the sole, and on the fingernails. Therefore, the development of acral melanoma may be associated with chronic pressure, physical stress, or trauma. Dermoscopy is a useful adjunctive diagnostic tool for differential diagnosis. Acral melanocytic nevus is characterized by a parallel furrow pattern, whereas acral melanoma has a parallel ridge pattern. Genetic alterations are also different between the two types of lesion. BRAF and NRAS mutations are common in acral melanocytic nevus, whereas acral melanoma shows lower rates of KIT, NF1, BRAF, and NRAS mutations and remarkable copy number variations in genes such as CCND1, CDK4, hTERT, PAK1, and GAB2. Sentinel lymph node biopsy is important for staging and prognosis. Contemporary treatments for melanoma include targeted therapy for mutations and immunotherapy, such as anti-PD1 inhibitors.
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Affiliation(s)
- Sanghyun Park
- Department of Dermatology, Chonnam National University Hwasun Hospital, Hwasun 58128, Korea
| | - Sook-Jung Yun
- Department of Dermatology, Chonnam National University Hwasun Hospital, Hwasun 58128, Korea
- Department of Dermatology, Chonnam National University Medical School, Gwangju 59626, Korea
- Correspondence:
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9
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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] [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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10
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Ríos-Viñuela E, Manrique-Silva E, Nagore E, Nájera-Botello L, Requena L, Requena C. [Translated article] Subungual Melanocytic Lesions in Pediatric Patients. ACTAS DERMO-SIFILIOGRAFICAS 2022. [DOI: 10.1016/j.ad.2021.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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11
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Ríos-Viñuela E, Manrique-Silva E, Nagore E, Nájera-Botello L, Requena L, Requena C. Subungual Melanocytic Lesions in Pediatric Patients. ACTAS DERMO-SIFILIOGRAFICAS 2022; 113:388-400. [PMID: 35623729 DOI: 10.1016/j.ad.2021.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/05/2021] [Accepted: 10/11/2021] [Indexed: 01/07/2023] Open
Abstract
The study of subungual melanocytic lesions can present challenges because of the clinical and histologic characteristics of the nail unit and the difficulty of performing nail biopsies and processing specimens. These lesions can be even more challenging in children due to differences in clinical and epidemiological profiles between the adult and pediatric populations. Many of the clinical features of subungual melanocytic lesions that would raise alarm in an adult do not have the same implications in children. Consensus is also lacking on when a nail biopsy is needed to rule out malignancy in the pediatric setting. In view of these considerations and the rarity of subungual melanoma in childhood, the recommended approach in most cases is a watch-and-wait strategy. Subungual melanocytic lesions in children may also show atypical histopathologic features that are not necessarily associated with aggressive behavior. Subungual melanoma is very rare in childhood, with just 21 cases described to date. None of the patients developed visceral metastasis or died as a result and the diagnosis was controversial in many of the cases. Considering the above and the significantly higher frequency and particular characteristics of longitudinal melanonychia with a benign etiology in children, subungual melanocytic lesions should be managed differently in this setting than in adults. In most cases, a watch-and-wait approach is the most appropriate strategy.
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Affiliation(s)
- E Ríos-Viñuela
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España.
| | - E Manrique-Silva
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España
| | - E Nagore
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España
| | - L Nájera-Botello
- Servicio de Anatomía Patológica, Hospital Universitario Puerta del Hierro, Madrid, España
| | - L Requena
- Servicio de Dermatología, Fundación Jiménez Díaz, Madrid, España
| | - C Requena
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España
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12
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Tsiogka A, Laimer M, Rigopoulos D, Ahlgrimm-Siess V. Equivocal Longitudinal Melanonychia in a 3-Year-Old Caucasian Girl: Rapid Evolution and Fading during Digital Dermoscopy Follow-Up. Skin Appendage Disord 2022; 8:150-153. [PMID: 35419417 PMCID: PMC8928206 DOI: 10.1159/000519561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 09/02/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction Nail matrix nevi (NMN) in pediatric patients manifest as longitudinal melanonychia (LM) and can share clinical, dermoscopic, and histopathological characteristics with subungual melanoma. Equivocal findings in childhood LM may reflect dynamic processes during the natural life cycle of NMN in children. Case Presentation We present a case of a heavily pigmented LM with equivocal clinical and dermoscopic findings in a 3-year-old Caucasian girl, which exhibited signs of evolution, maturation, and almost complete involution within a short time period during digital follow-up, attributed to the natural course of NMN. Discussion/Conclusion Considering the rarity of subungual melanoma in childhood, our case underlines the significance of clinical and digital dermoscopy follow-up in the evaluation of childhood LM in order to avoid unnecessary biopsies and potential permanent nail dystrophy.
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Affiliation(s)
- Aikaterini Tsiogka
- 1st Department of Dermatology-Venereology, Andreas Sygros Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece,*Aikaterini Tsiogka,
| | - Martin Laimer
- Department of Dermatology and Allergology, University Hospital and Paracelsus Private Medical University, Salzburg, Austria
| | - Dimitrios Rigopoulos
- 1st Department of Dermatology-Venereology, Andreas Sygros Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Verena Ahlgrimm-Siess
- Department of Dermatology and Allergology, University Hospital and Paracelsus Private Medical University, Salzburg, Austria
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13
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Darmawan CC, Ohn J, Mun J, Kim S, Lim Y, Jo SJ, Kim Y, Kim B, Seong M, Kim BJ, Lee C, Kwak Y, Chung HJ, Virós A, Lee D. Diagnosis and treatment of nail melanoma: A review of the clinicopathologic, dermoscopic, and genetic characteristics. J Eur Acad Dermatol Venereol 2022; 36:651-660. [DOI: 10.1111/jdv.17975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 12/20/2021] [Accepted: 01/07/2022] [Indexed: 12/01/2022]
Affiliation(s)
- C. C. Darmawan
- Department of Dermatology Seoul National University College of Medicine 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
- Institute of Human‐Environment Interface Biology Seoul National University 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
| | - J. Ohn
- Department of Dermatology Seoul National University College of Medicine 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
- Institute of Human‐Environment Interface Biology Seoul National University 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
| | - J.‐H. Mun
- Department of Dermatology Seoul National University College of Medicine 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
- Institute of Human‐Environment Interface Biology Seoul National University 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
- Department of Dermatology Seoul National University Hospital 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
- Skin Cancer/Chemotherapy Skin Care Center Seoul National University Cancer Hospital 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
| | - S. Kim
- Department of Dermatology Seoul National University Hospital 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
| | - Y. Lim
- Department of Dermatology Seoul National University Hospital 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
- Skin Cancer/Chemotherapy Skin Care Center Seoul National University Cancer Hospital 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
| | - S. J. Jo
- Department of Dermatology Seoul National University College of Medicine 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
- Institute of Human‐Environment Interface Biology Seoul National University 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
- Department of Dermatology Seoul National University Hospital 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
- Skin Cancer/Chemotherapy Skin Care Center Seoul National University Cancer Hospital 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
| | - Y.‐g. Kim
- Department of Laboratory Medicine Green Cross Genomic Laboratories 107 Ihyeonro 30beon‐gil Giheng‐gu Yongin‐Si Gyeonggi‐do 16924 Korea
| | - B. Kim
- Department of Laboratory Medicine Seoul National University College of Medicine 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
| | - M.‐W. Seong
- Department of Laboratory Medicine Seoul National University College of Medicine 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
| | - B. J. Kim
- Department of Plastic and Reconstructive Surgery Seoul National University College of Medicine 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
| | - C. Lee
- Department of Pathology Seoul National University College of Medicine 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
| | - Y. Kwak
- Department of Pathology Seoul National University College of Medicine 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
| | - H. J. Chung
- Department of Dermatology Harvard Medical School Boston Massachusetts 02215 USA
| | - A. Virós
- Skin Cancer and Ageing Lab Cancer Research UK Manchester Institute The University of Manchester Manchester SK10 4TG UK
| | - D.Y. Lee
- Department of Dermatology Samsung Medical Center Sungkyunkwan University 81 Irwon‐Ro, Gangnam‐gu Seoul 06351 Korea
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14
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An Evidence-Based Approach to Pediatric Melanonychia. Dermatol Clin 2021; 40:37-49. [PMID: 34799034 DOI: 10.1016/j.det.2021.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Melanonychia including melanonychia striata in children poses a diagnostic dilemma. Atypical clinical features often raise the possibility of malignancy, and a nail unit biopsy may be recommended. Commensurate with atypical clinical features, the histopathology may also appear alarming. However, accumulating data illustrate that most cases of melanonychia striata are benign and suggest that an alternate approach is often warranted for pediatric patients. Herein, we review the existing data regarding pediatric melanonychia striata and offer an evidence-based approach to its evaluation and management.
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15
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Ansari MS, Mahmoudi H, Sadeghinia A, Azizzadeh-Roodpishi S, Ghanadan A, Daneshpazhooh M. Dermoscopic Evaluation of Longitudinal Melanonychia in Children: A Prospective Study. Indian J Dermatol 2021; 66:445. [PMID: 34759421 PMCID: PMC8530064 DOI: 10.4103/ijd.ijd_722_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Background: Longitudinal melanonychia (LM) is a worrisome sign in both children and adults. Nail apparatus melanoma (NAM) can be related to LM, but it is very rare in children. Dermoscopic signs of benign lesions in children can be similar to melanoma; therefore, it is important to review dermoscopy of LM in children to make the best decision in performing biopsy. Aims: Biopsy taking is very challenging in LM in children. Most lesions are benign in children. The aim of this study was to review dermoscopic signs of LM in children and compare them with adults. Materials and Methods: In this prospective study a total of 108 LM (35 children and 73 adults) were undergone dermoscopy of LM. Dermoscopic features were compared in children and adults; both for benign lesions proven by biopsy or follow up and melanomas diagnosed histopathologically. Results: Black background, black band color, band color diversity and pseudo-Hutchinson's sign were more frequent in children in comparison with benign adult melanonychia. Some children's dermoscopic features of LM such as broad band width, Band color diversity, Hutchinson's sign, gray band color, asymmetry of pattern, and regression were similar to melanoma, but we did not find any melanoma by biopsy and/or follow up among children. We also detected the newly described "zigzag" pattern in four children. Conclusion: Dermatologists should consider all dermoscopic features of a lesion, dermoscopic sign changes in follow-up, medical, and familial history of the patient in deciding to perform biopsy of LM in children.
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Affiliation(s)
- Mahshid Sadat Ansari
- Department of Dermatopathology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Mahmoudi
- Department of Dermatopathology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Sadeghinia
- Department of Dermatopathology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Alireza Ghanadan
- Department of Dermatopathology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Daneshpazhooh
- Department of Dermatopathology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
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16
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Abstract
Nail pigmentation in children can cause significant anxiety in parents and clinicians. Different pigments of the nails, such as yellow, orange, and green, can all occur; however, this paper will focus on the dark pigments: brown, gray, and black pigmentation of the nails. Many causes of dark coloration of the nails exist; almost all causes in pediatric patients are benign and require no treatment. Melanoma is the one diagnosis that physicians do not want to miss. Fortunately, this is extremely rare in children.
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Affiliation(s)
- Jane Sanders Bellet
- Departments of Dermatology and Pediatrics, Duke University School of Medicine, Durham, NC, USA
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17
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Mitchell KN, Tay YK, Heath CR, Silverberg NB. Review article: Emerging issues in pediatric skin of color, Part 2. Pediatr Dermatol 2021; 38 Suppl 2:30-36. [PMID: 34708446 DOI: 10.1111/pde.14774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Dermatology for pediatric skin of color is the application of dermatology to the genetically diverse and distinctive segment of the pediatric population that includes children of non-White racial and ethnic groups with increased pigmentation including individuals of Asian, Hispanic/LatinX, African, Native American, Pacific Island descent, indigenous people among others with overlap in particular individuals, and mixtures thereof. The discipline of pediatric skin of color can be challenging with difficulty in diagnosis of common conditions due to underlying pigmentation, variations in common hair styling practices, and differences in demographics of cutaneous disease. Whereas some conditions are more common in children of color, other conditions have nuances in clinical appearance and therapeutics with regard to skin color. This article, the second of the series, focuses on inflammatory skin disease nuances, melanocytic disorders, and hypopigmented mycosis fungoides.
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Affiliation(s)
- Krystal N Mitchell
- Department of Dermatology, Icahn School of Medicine at Mt Sinai, New York, NY, USA
| | - Yong Kwang Tay
- Department of Dermatology, Changi General Hospital, Singapore, Singapore
| | - Candrice R Heath
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Nanette B Silverberg
- Department of Dermatology, Icahn School of Medicine at Mt Sinai, New York, NY, USA
- Department of Pediatrics, Icahn School of Medicine at Mt Sinai, New York, NY, USA
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18
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Oh SJ, Lee J, Lee JH, Bae J, Park JH, Lee JH, Lee D. Distribution of cellular remnants of melanocytes in the nail plate: Clue to the diagnosis of subungual melanoma. J Cutan Pathol 2021; 49:331-337. [PMID: 34643958 DOI: 10.1111/cup.14150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 09/17/2021] [Accepted: 10/02/2021] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Se Jin Oh
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | - Jongeun Lee
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | - Jae Ho Lee
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | - Jaihee Bae
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | - Ji-Hye Park
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | - Jong Hee Lee
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | - Dongyoun Lee
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
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19
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Lee J, Bae J, Lee D. Melanocytic nevi on the hyponychium with dermoscopic features of longitudinal brush pigmentation in children. Pediatr Dermatol 2021; 38:1264-1266. [PMID: 34515369 DOI: 10.1111/pde.14794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The dermoscopic features of longitudinally aligned pigmentation on the hyponychium were previously described in pediatric patients with longitudinal melanonychia. We report four cases of biopsy-proven acral melanocytic nevi on the hyponychium with a longitudinal brush pigmentation (LBP) pattern in dermoscopy. This LBP pattern on the hyponychium may be a counterpart of the fibrillar pattern of acral melanocytic nevi. Therefore, the LBP pattern in dermoscopy may provide a useful clue for distinguishing benign melanocytic nevi from melanoma in pediatric patients.
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Affiliation(s)
- Jongeun Lee
- Departments of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jaihee Bae
- Departments of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dongyoun Lee
- Departments of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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20
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Ren J, Ren M, Kong YY, Lv JJ, Cai X, Kong JC. Clinicopathological diversity and outcome of longitudinal melanonychia in children and adolescents: analysis of 35 cases identified by excision specimens. Histopathology 2021; 77:380-390. [PMID: 32314423 DOI: 10.1111/his.14121] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 04/16/2020] [Indexed: 02/03/2023]
Abstract
AIMS Longitudinal melanonychia in paediatric patients often represents a difficult diagnostic challenge, and studies emphasising its clinical and histopathological features are limited due to its low incidence in childhood. METHODS AND RESULTS We retrospectively analysed 35 paediatric cases identified by excision specimens on their clinicopathological features, and performed fluorescence in-situ hybridisation on 13 available cases. Fingernails (77.1%) were more likely to be affected. Total melanonychia and Hutchinson's sign were observed in 10 (28.6%) and 14 (40.0%) cases, respectively. Nail dystrophy at diagnosis was present in five cases. After complete excision of the lesions, four patients relapsed during follow-up (mean = 38 months). Seventeen cases were diagnosed as lentigines and 18 as naevi, among which 11 cases were categorised as lentigines/naevi with atypical melanocytic hyperplasia. Mild-to-moderate nuclear atypia, confluency of melanocytes, focal pagetoid spread and peri-ungual skin involvement were found in 25.7% (9 of 35), 40.0% (14 of 35), 40.0% (14 of 35) and 40.0% (14 of 35) of cases, respectively. Thirteen cases tested by fluorescence in-situ hybridisation showed no copy number aberration at the probed loci. There was a statistically significant difference in the following features between patients aged less and more than 10 years (P < 0.05): cytomorphology, mild-to-moderate nuclear atypia, confluency of melanocytes, focal pagetoid spread and melanocyte count. CONCLUSIONS Some concerning clinicopathological characteristics, which are signs indicative of melanoma in adults, are not uncommon in paediatric longitudinal melanonychia, especially in patients aged ≤ 10 years. Owing to the extremely low incidence of melanoma in paediatric longitudinal melanonychia, in most circumstances a more conservative clinical management strategy should be adopted.
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Affiliation(s)
- Jing Ren
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Min Ren
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yun-Yi Kong
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jiao-Jie Lv
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xu Cai
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jin-Cheng Kong
- Department of Pathology, First People's Hospital, Shanghai Jiaotong University, Shanghai, China
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21
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Dany M, Fischer AS, Pei S, Rubin AI. Updates on the Pathology and Management of Nail Unit Tumors and Dermatoses. Surg Pathol Clin 2021; 14:327-339. [PMID: 34023109 DOI: 10.1016/j.path.2021.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Nail unit pathology is indispensable to reach an accurate diagnosis of nail tumors as well as inflammatory disorders. This review article provides an update from the most recently published studies on the pathology and management of nail unit tumors and inflammatory disorders. Recent findings of nail clipping histopathology are described first, followed by discussing recent data on the diagnosis and surgical management of several types of nail unit tumors, ending with discussing the recent discoveries in selected nail unit inflammatory disorders.
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Affiliation(s)
- Mohammed Dany
- Department of Dermatology, Hospital of the University of Pennsylvania, University of Pennsylvania, 3600 Spruce Street, 2 Maloney Building, Philadelphia, PA 10104, USA
| | - Andrew S Fischer
- Department of Dermatology, Hospital of the University of Pennsylvania, University of Pennsylvania, 3600 Spruce Street, 2 Maloney Building, Philadelphia, PA 10104, USA
| | - Susan Pei
- Department of Dermatology, Hospital of the University of Pennsylvania, University of Pennsylvania, 3600 Spruce Street, 2 Maloney Building, Philadelphia, PA 10104, USA
| | - Adam I Rubin
- Department of Dermatology, Hospital of the University of Pennsylvania, University of Pennsylvania, 3600 Spruce Street, 2 Maloney Building, Philadelphia, PA 10104, USA; Hospital of the University of Pennsylvania, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, University of Pennsylvania, 3600 Spruce Street, 2 Maloney Building, Philadelphia, PA 10104, USA.
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22
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Ríos-Viñuela E, Nájera-Botello L, Requena L, Nagore E, Requena C. Subungual Melanocytic Lesions: Key Clinical and Pathologic Concepts and Biopsy Techniques. ACTAS DERMO-SIFILIOGRAFICAS 2021; 112:S1578-2190(21)00166-9. [PMID: 34053897 DOI: 10.1016/j.adengl.2021.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 12/26/2020] [Indexed: 11/15/2022] Open
Abstract
Both dermatologists and pathologists sometimes find daunting the evaluation of melanonychia (especially subungual melanocytic lesions) because of the fear of performing nail surgery due to the risk of dystrophy, difficulties processing and interpreting nail biopsy specimens, and a general lack of experience in the field. Nevertheless, mastery of nail biopsy techniques, correct processing and orientation of specimens, and familiarity with the histologic particularities of the nail apparatus can attenuate the undoubted complexity and facilitate the tasks involved. Longitudinal excision is the biopsy technique that ensures the simplest histologic interpretation, and it is associated with a low risk of nail dystrophy when performed correctly. Clinical and epidemiological data are crucial. Subungual melanoma in childhood, for instance, is very rare and even lesions with atypical clinical and/or histologic features are probably benign. The presence of suprabasal melanocytes and other findings that would suggest malignancy at other sites are considered normal in the nail apparatus. Subungual melanoma shows a lentiginous pattern in the early stages of disease, and detection of an inflammatory infiltrate accompanying atypical lentiginous subungual lesions would appear to be one of the first diagnostic findings.
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Affiliation(s)
- E Ríos-Viñuela
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, Spain.
| | - L Nájera-Botello
- Servicio de Anatomía Patológica, Hospital Universitario Puerta del Hierro, Madrid, Spain
| | - L Requena
- Servicio de Dermatología, Fundación Jiménez Díaz, Madrid, Spain
| | - E Nagore
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, Spain
| | - C Requena
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, Spain
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23
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Abstract
This article discusses the histologic findings in key nail unit diseases, including inflammatory, infectious, and neoplastic conditions. The emphasis is on clinicopathologic correlates, best practices to demonstrate the relevant histopathologic features, and pitfalls in diagnosis. Understanding the pathology of these disorders enhances clinical acumen and may affect the choice of biopsy procedures and treatment measures, with the outcome of better clinical care for patients with nail disease.
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Affiliation(s)
- Beth S Ruben
- Palo Alto Medical Foundation Medical Group, Dermatology, 795 El Camino Real, Clark Building, 2nd Floor, Palo Alto, CA 94301, USA.
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24
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Ríos-Viñuela E, Nájera-Botello L, Requena L, Nagore E, Requena C. Subungual Melanocytic Lesions: Key Clinical and Pathologic Concepts and Biopsy Techniques. ACTAS DERMO-SIFILIOGRAFICAS 2021; 112:S0001-7310(21)00003-X. [PMID: 33465340 DOI: 10.1016/j.ad.2020.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/11/2020] [Accepted: 12/26/2020] [Indexed: 12/11/2022] Open
Abstract
Both dermatologists and pathologists sometimes find daunting the evaluation of melanonychia (especially subungual melanocytic lesions) because of the fear of performing nail surgery due to the risk of dystrophy, difficulties processing and interpreting nail biopsy specimens, and a general lack of experience in the field. Nevertheless, mastery of nail biopsy techniques, correct processing and orientation of specimens, and familiarity with the histologic particularities of the nail apparatus can attenuate the undoubted complexity and facilitate the tasks involved. Longitudinal excision is the biopsy technique that ensures the simplest histologic interpretation, and it is associated with a low risk of nail dystrophy when performed correctly. Clinical and epidemiological data are crucial. Subungual melanoma in childhood, for instance, is very rare and even lesions with atypical clinical and/or histologic features are probably benign. The presence of suprabasal melanocytes and other findings that would suggest malignancy at other sites are considered normal in the nail apparatus. Subungual melanoma shows a lentiginous pattern in the early stages of disease, and detection of an inflammatory infiltrate accompanying atypical lentiginous subungual lesions would appear to be one of the first diagnostic findings.
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Affiliation(s)
- E Ríos-Viñuela
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España.
| | - L Nájera-Botello
- Servicio de Anatomía Patológica, Hospital Universitario Puerta de Hierro, Madrid, España
| | - L Requena
- Servicio de Dermatología, Fundación Jiménez Díaz, Madrid, España
| | - E Nagore
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España
| | - C Requena
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España
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25
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Lee J, Park S, Lee D, Jang KT, Kwon EJ. Longitudinal brush pigmentation on the hyponychium, a dermoscopic feature observed in pediatric nail matrix nevi. J Am Acad Dermatol 2020; 84:1758-1760. [PMID: 33221465 DOI: 10.1016/j.jaad.2020.11.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 10/12/2020] [Accepted: 11/05/2020] [Indexed: 02/03/2023]
Affiliation(s)
- Jongeun Lee
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sewon Park
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dongyoun Lee
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Kee-Taek Jang
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Ji Kwon
- Morristown Pathology Associates, Morristown, NJ
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26
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Abstract
PURPOSE OF REVIEW Nail disorders represent an uncommon subset of complaints seen in pediatric dermatology. There is a wide array of disorders that can affect the nail unit in children, including infectious, inflammatory, neoplastic, congenital, and traumatic processes. In order to enhance familiarity with pediatric nail conditions, we review the background and treatment of the more common entities seen in pediatric onychology, including onychomycosis, onychomadesis, nail psoriasis, trachyonychia, longitudinal melanonychia, onychophagia, and onychocryptosis. RECENT FINDINGS Nail involvement in pediatric patients with psoriasis may indicate increased risk for both overall disease severity and the development psoriatic arthritis. In the evaluation of longitudinal melanonychia, the clinical findings that raise concern for subungual melanoma in adults are often found in benign nail unit nevi in children. In the systemic treatment of pediatric onychomycosis, new data raises the possibility that laboratory monitoring may be approached differently. In the approach to onychophagia, emerging pharmacotherapies include N-acetylcysteine. SUMMARY Most nail disorders in pediatric patients have an overall favorable prognosis. However, nail abnormalities can lead to patient and parental anxiety, decreased quality of life, pain, and functional impairment. Clinicians should be aware of these more common diverse entities in order to identify them and apply state of the art management for these issues. Additionally, the reader will learn factors related to these nail disorders, which may require systemic work-up and/or specialist referral.
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27
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Stefanaki C, Soura E, Sgouros D, Leotsakos G, Rigopoulos D, Stratigos A, Kontochrostopoulos G. Nail matrix naevi in children: a prospective study. J Eur Acad Dermatol Venereol 2020; 34:e203-e205. [PMID: 31850539 DOI: 10.1111/jdv.16154] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- C Stefanaki
- Pediatric Dermatology Clinic, Andreas Sygros University Skin Hospital, Athens, Greece
| | - E Soura
- Pediatric Dermatology Clinic, Andreas Sygros University Skin Hospital, Athens, Greece
| | - D Sgouros
- First Dermatology Clinic, Sygros University Skin Hospital, Athens, Greece
| | - G Leotsakos
- Pediatric Dermatology Clinic, Andreas Sygros University Skin Hospital, Athens, Greece
| | - D Rigopoulos
- First Dermatology Clinic, Sygros University Skin Hospital, Athens, Greece
| | - A Stratigos
- First Dermatology Clinic, Sygros University Skin Hospital, Athens, Greece
| | - G Kontochrostopoulos
- Pediatric Dermatology Clinic, Andreas Sygros University Skin Hospital, Athens, Greece
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28
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A comparative study of dermoscopic features and monitoring of congenital and acquired nevi of the nail apparatus in pediatric patients. J Am Acad Dermatol 2020; 83:1210-1212. [PMID: 32088270 DOI: 10.1016/j.jaad.2020.02.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 02/02/2020] [Accepted: 02/12/2020] [Indexed: 11/24/2022]
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29
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Dika E, Starace M, Lambertini M, Patrizi A, Veronesi G, Alessandrini A, Piraccini BM. Oral and nail pigmentations: a useful parallelism for the clinician. J Dtsch Dermatol Ges 2020; 18:7-14. [PMID: 31951106 DOI: 10.1111/ddg.14023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 07/21/2019] [Indexed: 12/20/2022]
Abstract
Oral (OP) and nail (NP) pigmentations may occur simultaneously in physiological or pathological conditions, and may be a sign of underlying syndromic conditions that necessitate further investigation and treatment. Interestingly, the nail unit and oral cavity show a clinical parallelism that may help the clinician to conduct a correct examination and reach a prompt diagnosis. Both OP and NP can manifest clinically with focal or diffuse involvement and are due to external factors (exogenous pigmentation, drug-induced pigmentation) or endogenous factors (racial pigmentation, post-inflammatory pigmentation, nevi, genetic conditions and other disorders). The most concerning differential diagnosis is melanoma. Here we report the pathogenetic basis of OP and NP, together with the description of similar clinical features. To the best of our knowledge this is the first paper to summarize and describe the causes of pigmentation of both the oral cavity and the nail unit.
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Affiliation(s)
- Emi Dika
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Michela Starace
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Martina Lambertini
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Annalisa Patrizi
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Giulia Veronesi
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Aurora Alessandrini
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Bianca Maria Piraccini
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
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30
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Dika E, Starace M, Lambertini M, Patrizi A, Veronesi G, Alessandrini A, Piraccini BM. Orale und Nagelpigmentierungen: eine für den Kliniker nützliche Parallelität. J Dtsch Dermatol Ges 2020; 18:7-16. [DOI: 10.1111/ddg.14023_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 07/21/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Emi Dika
- DermatologyDepartment of ExperimentalDiagnostic and Specialty MedicineUniversity of Bologna Bologna Italy
| | - Michela Starace
- DermatologyDepartment of ExperimentalDiagnostic and Specialty MedicineUniversity of Bologna Bologna Italy
| | - Martina Lambertini
- DermatologyDepartment of ExperimentalDiagnostic and Specialty MedicineUniversity of Bologna Bologna Italy
| | - Annalisa Patrizi
- DermatologyDepartment of ExperimentalDiagnostic and Specialty MedicineUniversity of Bologna Bologna Italy
| | - Giulia Veronesi
- DermatologyDepartment of ExperimentalDiagnostic and Specialty MedicineUniversity of Bologna Bologna Italy
| | - Aurora Alessandrini
- DermatologyDepartment of ExperimentalDiagnostic and Specialty MedicineUniversity of Bologna Bologna Italy
| | - Bianca Maria Piraccini
- DermatologyDepartment of ExperimentalDiagnostic and Specialty MedicineUniversity of Bologna Bologna Italy
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31
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Subungual atypical lentiginous melanocytic proliferations in children and adolescents: A clinicopathologic study. J Am Acad Dermatol 2018; 79:327-336.e2. [DOI: 10.1016/j.jaad.2018.03.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 03/11/2018] [Accepted: 03/14/2018] [Indexed: 11/22/2022]
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