1
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Haynes D, Haneke E, Rubin AI. Clinical, onychoscopic, nail clipping, and histopathological findings of malignant onychopapilloma. J Cutan Pathol 2024; 51:500-505. [PMID: 38563529 DOI: 10.1111/cup.14620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 03/04/2024] [Accepted: 03/17/2024] [Indexed: 04/04/2024]
Abstract
This report describes the clinical, onychoscopic, nail clipping, and histopathologic features of a malignant onychopapilloma. A 71-year-old male presented to our outpatient clinic for a stable, asymptomatic lesion on his left middle finger that had been present for 2 years. Prior nail clipping histopathology showed nail plate thinning with subungual abnormal onychocytes. Clinical examination revealed a 2-mm-wide streak of longitudinal xanthonychia extending to the proximal nail fold, with distal hyperkeratosis and onycholysis. Onychoscopy showed irregular longitudinal nail plate ridging with scattered punctate hemorrhagic foci. An excisional nail unit biopsy demonstrated cellular atypia of the nail bed epithelium, matrix metaplasia, longitudinal abnormal onychocytes, increased Ki-67 staining, and negative HPV immunoperoxidase staining, confirming the diagnosis of malignant onychopapilloma.
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Affiliation(s)
- Dylan Haynes
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Eckart Haneke
- Dermatology Practice Dermaticum, Freiburg, Germany
- Department of Dermatol, Inselspital, Univ Berne, Switzerland
- Centro Dermatol Epidermis, Inst CUF, Porto, Portugal
| | - Adam I Rubin
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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2
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Perrin C, Coutts M, Boukari F, Ambrosetti D. Onychocytic Matricoma: A Clinical, Dermoscopic, and Pathological Analysis of 14 Cases. Am J Dermatopathol 2024; 46:259-270. [PMID: 38513115 PMCID: PMC11027982 DOI: 10.1097/dad.0000000000002674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
ABSTRACT Onychocytic matricoma (OCM) is a benign neoplasm of the nail matrix. Only 18 cases of this tumor have been reported in the literature to date. We retrospectively analyzed the clinical features of 14 patients with OCM. The most common clinical feature was longitudinal xanthopachyonychia (n = 9), followed by longitudinal leukopachyonychia (=3) and longitudinal pachymelanonychia (n = 2). The most common clinical findings identified following dermoscopy and analysis at high magnification of classical photographs were free-edge thickening of the nail plate without pitting (n = 14), longitudinal ridging (n = 7), round white clods (n = 7), white dots (n = 7), and filiform hemorrhages (n = 7), followed by oval and linear white clods (n = 5), fuzzy lateral border (n = 5), and red-purple blood clods (n = 3). Nail clipping histopathology showed a thickened nail plate with multiple, small, round-to-oval spaces. The tumor expressed immunopositivity for LEF-1. Dermoscopy of the nail plate and nail clipping histology provides useful information with regards to the differential diagnosis with subungual squamous cell carcinoma and nail melanoma. Ex vivo-in vivo correlation facilitates a better dermoscopic assessment of this unique underrecognized disease. However, the differential diagnosis between OCM and onychocytic carcinoma requires biopsy of the tumor. LEF-1 as an onychogenic marker can be used to resolve the differential diagnosis between OCM and subungual longitudinal acanthoma/seborrheic keratosis.
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Affiliation(s)
- Christophe Perrin
- Dermatologists, Laboratoire Central d’Anatomie Pathologique, Nice University Hospital, University of Côte d’Azur (UCA), Nice, France
- Nail's Dermatology Consultations, Cannes, France
| | - Michael Coutts
- Department of Cellular Pathology, Maidstone Hospital, Kent, United Kingdom; and
| | - Feriel Boukari
- Department of Dermatology, Nice University Hospital, University of Côte d’Azur (UCA), Nice, France
| | - Damien Ambrosetti
- Dermatologists, Laboratoire Central d’Anatomie Pathologique, Nice University Hospital, University of Côte d’Azur (UCA), Nice, France
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3
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Arias-Rodriguez C, Castrillón M, Montes M, Ospina JP. Onychopapilloma: A Potential Mimicker. ACTAS DERMO-SIFILIOGRAFICAS 2024:S0001-7310(24)00050-4. [PMID: 38307171 DOI: 10.1016/j.ad.2023.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/27/2023] [Accepted: 07/03/2023] [Indexed: 02/04/2024] Open
Affiliation(s)
- C Arias-Rodriguez
- Department of Dermatology, Universidad Pontificia Bolivariana, Medicáncer, Aurora, Medellín, Colombia
| | | | - M Montes
- Aurora, Clínica Dermatológica Especializada, Medicáncer, Medellín, Colombia
| | - J P Ospina
- Centro de Investigaciones Dermatológicas (CIDERM), Universidad de Antioquia, Medellín, Colombia
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4
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Fernandez-Flores A. Basic Concepts in Nail Pathology. Am J Dermatopathol 2023; 45:675-693. [PMID: 37732686 DOI: 10.1097/dad.0000000000002466] [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: 09/22/2023]
Abstract
ABSTRACT Understanding nail pathology is complex for general pathologists and even for those dermatopathologists who do not receive many nail samples in their laboratories. In this article, we attempt to review some of the primary entities in nail pathology with the aid of modern interpretations of nail histology and embryology. We also provide diagrams that can aid in comprehending this field of pathology.
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Affiliation(s)
- Angel Fernandez-Flores
- Dermatopathologist, Department of Histopathology, University Hospital El Bierzo, Ponferrada, Spain
- Dermatopathologist, Department of Cellular Pathology, Hospital de la Reina, Ponferrada, Spain; and
- Dermatopathologist, Research Department, Institute for Biomedical Research of A Coruña (INIBIC), University of A Coruña (UDC), A Coruña, Spain
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5
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Perrin C. Preferentially Expressed Nuclear Antigen in Melanoma Expression in Melanocytic Activation (Melanotic Macule) of the Nail Unit. A Potential Diagnostic Pitfall? A Study of 3 Cases. Am J Dermatopathol 2022; 44:499-502. [PMID: 35220324 DOI: 10.1097/dad.0000000000002156] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Recent studies have argued that melanocyte preferentially expressed nuclear antigen in melanoma (PRAME) is a sensitive and specific immunohistochemical marker of melanoma, including acral melanoma. In addition, loss of p16 expression has recently been suggested to have diagnostic utility in acral melanocytic tumors. The purpose of this study was to report PRAME expression in 3 cases of melanocytic activation (MAN). There were 2 men and 1 woman ranging in age at diagnosis from 46 years to 78 years (mean 61, 6 years). All cases involved a single digit. One lesion was in the fingernail (fifth finger), whereas the remaining 2 lesions were in the toenails (hallux). All the patient presented with a longitudinal melanonychia. The width of the lesions varied from 3 mm (2 cases) to 4 mm (1 case). The duration of the lesions before diagnosis varied from 12 to 24 months. Distinction of MAN from melanoma in situ is not always easy. Some morphological misleading features are illustrated in this study: (1) the suprabasal location of matrix melanocytes with long and thick dendrites within the 2-4 germinative cell layers; (2) the microconfluence of 2 melanocytes and rare melanocytes with a relatively large nucleus, however in a general context of melanocyte scarcity; and (3) the occasional nonspecific nuclear microphtalmia-associated transcription factor (MITF) staining of keratogeneous cells. Such staining could suggest a pagetoid spread of melanocytes in the keratogenous zone. PRAME antibody revealed a strong and diffuse staining in all cases. In addition, all cases were p16 negative. In this study, the melanocyte count inferior to 9 melanocytes/mm and the lack of nuclear atypia or confluence of melanocytes permitted a confident diagnosis of MAN. Limitations of our study lie largely in the small number of cases. Despite this, the expression of PRAME in some MAN seems to hamper its diagnostic value in differentiating benign from malignant lesion.
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Affiliation(s)
- Christophe Perrin
- Laboratoire Central D'Anatomie Pathologique, Hôpital L. Pasteur, University of Nice, Nail's Dermatology Consultations, Nice, Cannes, France
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Martin B, de la Fouchardiere A, Markiewicz D, Bartolo E, Bhargava K, Lewis F, Calonje E. Subungual melanoma with blue naevus-like morphological features: a clinicopathological retrospective analysis of nine cases. Pathology 2022; 54:541-547. [PMID: 35346503 DOI: 10.1016/j.pathol.2021.12.293] [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: 07/26/2021] [Revised: 11/22/2021] [Accepted: 12/03/2021] [Indexed: 11/29/2022]
Abstract
Melanocytic lesions in the nail apparatus are often challenging. Both subungual melanomas (SUM) and blue naevus of the nail are very rare. Occasionally, melanomas may mimic blue naevus histologically. Benign and malignant blue melanocytic lesions are commonly associated with G protein mutations, a distinct abnormality not associated with conventional subungual melanomas. We describe the clinical, histological and immunohistochemical features of nine cases of SUM with blue naevus-like morphological features. Mutations in exon 4 and 5 of GNAQ and GNA11 were investigated in two cases, which showed no mutations. RNA-seq of one case revealed unknown mutations along with mutations in ATM, METK and ARID1A. Our study delineates a variant of SUM that mimics blue naevus. Awareness of this pitfall is important when evaluating heavily pigmented lesions around the nail in order to avoid misdiagnosis. Appropriate sampling of subungual lesions and clinicopathological correlation are paramount to reach the correct diagnosis.
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Affiliation(s)
- Blanca Martin
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Trust, London, UK.
| | | | | | | | - Kapil Bhargava
- The Royal London Hospital - Barts Health NHS Trust, London, UK
| | - Fiona Lewis
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Trust, London, UK
| | - Eduardo Calonje
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Trust, London, UK
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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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Proliferating Onychomatricoma. Clinical, Dermoscopical, and Pathologic Features of Onychomatricoma New Variant Resembling Onycholemmal/Squamous Cell Carcinoma. Am J Dermatopathol 2021; 42:827-834. [PMID: 32271204 DOI: 10.1097/dad.0000000000001648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Proliferating onychomatricoma is a new challenging variant of onychomatricoma that can clinically and histologically mimic squamous cell carcinoma/onycholemmal carcinoma. This is a retrospective case series study of the clinicopathologic and dermoscopic features of 6 patients with a pathologic diagnosis of proliferating onychomatricoma, which was conducted in the dermatology and dermatopathology departments of 2 university hospitals and a private nail's dermatology consultation. The clinical, histological, and immunohistochemical features and follow-up of 6 patients with proliferating onychomatricoma were analyzed; we compare our finding with 6 cases of conventional onychomatricoma. The female-to-male ratio was 1:1 with involvement of fingers in 4 and toe in 2. Among the symptoms were verrucous lesion simulating squamous cell carcinoma, nail thickening, periungual erythema, and pain; symptom duration ranged from 5 to 8 years. Clinical, dermoscopical en face free-margin view, and nail-clipping histologic findings reveal a nail wall-like pattern with pitting. Intraoperative, noncontact, polarizing, light dermoscopy was available in 1 case and showed the typical signs of onychomatricoma (OM). Histologically, all cases showed a well-differentiated, infiltrative, squamous, proliferative lesion exhibiting a lobulated and cystic pattern of growth in the dermis. Abrupt keratinization reminiscent of trichilemmal keratinization, but corresponding in fact to keratogenous spheres, was noted as well as a dysmaturative epithelial pattern. No atypical cytomorphological changes were found. Proliferating onychomatricoma is a new variant of onychomatricoma, which can be misdiagnosed as squamous cell carcinoma/onycholemmal carcinoma; its proper recognition may minimize morbidity associated with inappropriate treatment. Proliferating OM can be differentiated from conventional OM clinically by a free-edge wall-like pattern and on histology of nail clipping by the relatively small size of the cavities. Dermoscopic and nail clipping attributes as free-edge honeycomb-like cavities associated with conventional OM are well established and permit a diagnosis of OM without an invasive nail biopsy. The free-edge wall-like pattern is a distinct new dermoscopic and nail-clipping pattern that should raise for the others onychogenic neoplasms and prompt the clinician to obtain a biopsy specimen. In addition to proliferating OM, the differential diagnosis includes a micropapilliferum variant of OM, onychocytic matricoma, and onychocytic carcinoma.
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9
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Starace M, Alessandrini A, Piraccini BM. Dermoscopy of the Nail Unit. Dermatol Clin 2021; 39:293-304. [PMID: 33745641 DOI: 10.1016/j.det.2020.12.008] [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: 10/22/2022]
Abstract
Nail dermoscopy (onychoscopy) is being used for a more accurate diagnosis of all nail disorders and has become a routine diagnostic instrument. In daily practice, nail signs can be magnified, and dermoscopy may confirm the clinical diagnosis and guides in management of nail diseases and treatments, permitting a better visualization of symptoms. Onychoscopy is used by the experts in almost all nail diseases. It can be performed dry or with ultrasound gel in order to make the stratum corneum translucent, depending on which part of the nail unit has to be evaluated.
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Affiliation(s)
- Michela Starace
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Via Massarenti 1, Bologna 40138, Italy.
| | - Aurora Alessandrini
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Via Massarenti 1, Bologna 40138, Italy
| | - Bianca Maria Piraccini
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Via Massarenti 1, Bologna 40138, Italy
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10
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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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11
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Abstract
Melanonychia represents a brown to black discoloration of the nail plate that may be induced by benign or malignant causes. Two main mechanisms are involved in the appearance of melanonychias, i.e., melanocytic activation and melanocytic hyperplasia. The distinction between the two can be made based on the medical history of the patient, the clinical picture, dermoscopy, and histopathological examination and is essential for the adequate management of the patient. We review the main causes of melanonychia, with emphasis on the clues to the diagnosis of subungual melanoma.
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Affiliation(s)
| | - Mara Mihai
- Oncologic Dermatology, Elias Emergency University Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
| | - Cristina Beiu
- Oncologic Dermatology, Elias Emergency University Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
| | | | - Calin Giurcaneanu
- Oncologic Dermatology, Elias Emergency University Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
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12
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Leung AKC, Lam JM, Leong KF, Sergi CM. Melanonychia striata: clarifying behind the Black Curtain. A review on clinical evaluation and management of the 21st century. Int J Dermatol 2019; 58:1239-1245. [DOI: 10.1111/ijd.14464] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/16/2019] [Accepted: 03/22/2019] [Indexed: 01/19/2023]
Affiliation(s)
| | - Joseph M. Lam
- Department of Pediatrics Department of Dermatology and Skin Sciences University of British Columbia Vancouver British Columbia Canada
| | - Kin Fon Leong
- Pediatric Institute Kuala Lumpur General Hospital Kuala Lumpur Malaysia
| | - Consolato M. Sergi
- Departments of Pediatrics, Laboratory Medicine, and Pathology The University of Alberta Edmonton Alberta Canada
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13
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Güneş P, Göktay F. Melanocytic Lesions of the Nail Unit. Dermatopathology (Basel) 2018; 5:98-107. [PMID: 30197884 PMCID: PMC6120410 DOI: 10.1159/000490557] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 05/24/2018] [Indexed: 11/19/2022] Open
Abstract
Melanocytic lesions of the nail unit are traditionally classified as follows: melanocytic activation, lentigo, nevi, and melanoma. Undoubtedly, melanoma is the most important malignant tumor of the nail unit. Differentiating nail unit melanoma from other melanocytic lesions is often difficult both clinically and histopathologically. This article will first describe the histology of the nail unit, followed by a brief summary of clinical and histopathological features as well as differential diagnosis of melanocytic lesions of the nail unit.
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Affiliation(s)
- Pembegül Güneş
- Department of Pathology, University of Health Sciences, Haydarpaşa Numune Training and Research Hospital, Istanbul, Turkey
| | - Fatih Göktay
- Department of Dermatology, University of Health Sciences, Haydarpaşa Numune Training and Research Hospital, Istanbul, Turkey
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14
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Melanocytes Pattern in the Normal Nail, With Special Reference to Nail Bed Melanocytes. Am J Dermatopathol 2018; 40:180-184. [DOI: 10.1097/dad.0000000000000940] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Germinotropic Onychocytic Matricoma: A New Histopathologic Subtype of Onychocytic Matricoma in the Light of the Microanatomy of the Normal Nail Unit, With Special Reference to Nail Mesenchyme. Am J Dermatopathol 2017; 39:e97-e101. [DOI: 10.1097/dad.0000000000000831] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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16
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Alessandrini A, Starace M, Piraccini BM. Dermoscopy in the Evaluation of Nail Disorders. Skin Appendage Disord 2017; 3:70-82. [PMID: 28560217 DOI: 10.1159/000458728] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 02/01/2017] [Indexed: 11/19/2022] Open
Abstract
Nail dermoscopy was initially used only in the assessment of nail pigmentation, but now it is widely utilized for the evaluation of many nail disorders. In daily practice, dermoscopy may confirm clinical diagnoses and guides in the management of nail diseases and treatments, permitting a better visualization of symptoms. Dry dermoscopy is required for evaluation of the nail plate surface, while gel as an interface is necessary for assessment of nail pigmentation and onycholysis, as well as for the evaluation of the distal nail margin. In this review, we describe the dermoscopic features of the most important nail disorders, looking at the different areas of the nail. Dermatoscopic changes that usually accompany specific nail diseases are also reviewed.
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Affiliation(s)
- Aurora Alessandrini
- 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
| | - Bianca Maria Piraccini
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
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17
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Abstract
Nail neoplasms include all tumors occurring in the nail or periungual apparatus tissue. While some nail tumors can be similar to tumors located on the skin, others are unique. Both benign and malignant lesions can affect the nail apparatus. In particular, early malignant tumors like melanoma and squamous cell carcinoma can present similarly to onychomycosis or benign melanonychia and frequently missed by clinicians. Therefore, physicians should be aware of nail structures and the characteristics of nail tumors. Our review covers the normal nail structure and the most common nail tumors from benign to malignant.
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Affiliation(s)
- Ji-Hye Park
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong-Youn Lee
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Noori Kim
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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18
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Fernandez-Flores A, Cassarino DS. Histopathological diagnosis of acral lentiginous melanoma in early stages. Ann Diagn Pathol 2017; 26:64-69. [PMID: 27601330 DOI: 10.1016/j.anndiagpath.2016.08.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 08/09/2016] [Accepted: 08/16/2016] [Indexed: 11/19/2022]
Abstract
Acral lentiginous melanoma is a rare variant of melanoma that is associated with a relatively low survival rate. The latter is partly due to the advanced stage in which the tumor is usually diagnosed. The diagnostic delay is mainly due to difficulties in identifying the very early histopathological signs of acral melanoma. The current article is a review of diagnostic clues, concepts, and definitions from the literature, as well as illustrating examples from our own archives. We have sought to provide an article that can be easily consulted in difficult cases of acral lentiginous melanoma.
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Affiliation(s)
| | - David S Cassarino
- Department of Pathology, Southern California Kaiser Permanente, Los Angeles Medical Center (LAMC), Kaiser Permanente, Los Angeles, CA 90027-5969
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19
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Acquired Localized (Monodactylous) Longitudinal Pachyonychia and Onychocytic Carcinoma In Situ (2 Cases): Part II. Am J Dermatopathol 2017; 39:40-44. [DOI: 10.1097/dad.0000000000000579] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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20
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Halteh P, Magro C, Scher RK, Lipner SR. Onychopapilloma Presenting as Leukonychia: Case Report and Review of the Literature. Skin Appendage Disord 2016; 2:89-91. [PMID: 28232912 DOI: 10.1159/000448105] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 06/29/2016] [Indexed: 11/19/2022] Open
Abstract
Onychopapilloma is a benign tumor of the nail bed and distal matrix and is the most common cause of localized longitudinal erythronychia. Here, we describe a case of onychopapilloma presenting as longitudinal leukonychia of the left 4th fingernail in a 71-year-old female. To date, this is only the ninth described case of onychopapilloma presenting as longitudinal leukonychia. We review the literature on the reported cases and provide evidence that longitudinal leukonychia as the presenting sign for onychopapilloma is becoming increasingly recognized in clinical practice.
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Affiliation(s)
- Pierre Halteh
- Department of Dermatology, Weill Cornell Medicine, New York, N.Y., USA
| | - Cynthia Magro
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, N.Y., USA
| | - Richard K Scher
- Department of Dermatology, Weill Cornell Medicine, New York, N.Y., USA
| | - Shari R Lipner
- Department of Dermatology, Weill Cornell Medicine, New York, N.Y., USA
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Acquired Localized Longitudinal Pachyonychia and Onychomatrical Tumors: A Comparative Study to Onychomatricomas (5 Cases) and Onychocytic Matricomas (4 Cases). Am J Dermatopathol 2016; 38:664-71. [DOI: 10.1097/dad.0000000000000511] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kamyab K, Abdollahi M, Nezam-Eslami E, Nikoo A, Balighi K, Naraghi ZS, Daneshpazhooh M. Longitudinal melanonychia in an Iranian population: a study of 96 patients. Int J Womens Dermatol 2016; 2:49-52. [PMID: 28492005 PMCID: PMC5412111 DOI: 10.1016/j.ijwd.2016.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 03/04/2016] [Accepted: 03/07/2016] [Indexed: 12/04/2022] Open
Abstract
Background Longitudinal melanonychia (LM) can be a challenging sign since it may be caused by a wide variety of benign and malignant conditions. Cutaneous melanoma is the most important cause of LM. Objective: We performed this study to examine different aspects of LM in Iran, where cutaneous melanoma is rare. Methods In this cross-sectional study, we reviewed medical records and pathology reports of a total of 96 patients presenting with LM. These patients had been visited and undergone nail biopsy in Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran. Demographic, clinical, and pathological data were recorded. Results The most common diagnosis was junctional nevi in 28 patients (29.2%) followed by melanoma in 19 patients (19.8%). Patients had a mean age of 42.4 years (± 19.4). The mean ages in the groups with junctional nevi and melanoma were 33.3 (± 19.5) and 51.9 (± 17.8), respectively; their difference was statistically significant (P value = 0.001). Hutchinson’s sign was present in 10 patients, 9 of which had melanoma. Also, melanoma was only observed in patients presenting with a solitary nail lesion. Nails mostly affected by melanoma were middle fingers of the hands (7 patients) and thumbs (6 patients). Out of 18 patients with nail dystrophy, 13 (72.2%) were diagnosed with melanoma. Limitations Only patients who have undergone biopsy were studied. Conclusion Melanoma is an important cause of LM in Iranian patients and should especially be suspected in older patients who present with a solitary nail lesion on their middle finger or thumb. Other findings that direct us toward melanoma are presence of Hutchinson’s sign and nail dystrophy.
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Affiliation(s)
- Kambiz Kamyab
- Department of Dermatopathology, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Abdollahi
- Department of Dermatopathology, Tehran University of Medical Sciences, Tehran, Iran
| | - Elaheh Nezam-Eslami
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences Tehran, Iran
| | - Azita Nikoo
- Department of Dermatopathology, Tehran University of Medical Sciences, Tehran, Iran
| | - Kamran Balighi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences Tehran, Iran
| | - Zahra S Naraghi
- Department of Dermatopathology, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Daneshpazhooh
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences Tehran, Iran.,Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences
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Wollina U, Baran R, Schönlebe J. Dystrophy of the Great Toenail by Subungual Exostosis and Hyperostosis: Three Case Reports with Different Clinical Presentations. Skin Appendage Disord 2016; 1:213-6. [PMID: 27386469 DOI: 10.1159/000445907] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 02/16/2016] [Indexed: 12/18/2022] Open
Abstract
Subungual exostoses and hyperostoses of the great toenail are a differential diagnosis of nail tumors. We present 3 cases of subungual exostosis/hyperostosis with secondary nail dystrophy: a 36- and a 37-year-old woman as well as an 8-year-old boy. Two of the 3 patients suffered from pain. The 2 female patients presented with the classic dorsolateral firm protrusion, while the child presented with bilateral nail dystrophy with lateral wall hypertrophy. In this later case, a bony ridge was identified, which is an unusual subungual, nonprotruding type of exostosis. The hypertrophic lateral walls were removed by the Vandenbos technique. In the 2 former cases, complete excision of the bony lesions was performed with a proximal block. Healing by second intention was uneventful.
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Affiliation(s)
- Uwe Wollina
- Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Dresden, Germany
| | | | - Jacqueline Schönlebe
- Institute of Pathology 'Georg Schmorl', Academic Teaching Hospital Dresden-Friedrichstadt, Dresden, Germany
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Moulonguet I, Goettmann-Bonvallot S. Mélanonychies longitudinales. Ann Dermatol Venereol 2016; 143:53-60; quiz 51-2. [DOI: 10.1016/j.annder.2015.10.592] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 10/07/2015] [Accepted: 10/30/2015] [Indexed: 11/30/2022]
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Park SW, Jang KT, Lee JH, Park JH, Kwon GY, Mun GH, Lee DY, Lee JB, Park KK. Scattered atypical melanocytes with hyperchromatic nuclei in the nail matrix: diagnostic clue for early subungual melanomain situ. J Cutan Pathol 2015; 43:41-52. [DOI: 10.1111/cup.12634] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Revised: 09/10/2015] [Accepted: 09/29/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Se-Won Park
- Department of Dermatology, Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul South Korea
| | - Kee-Taek Jang
- Department of Pathology, Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul South Korea
| | - Jae-Ho Lee
- Department of Dermatology, Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul South Korea
| | - Ji-Hye Park
- Department of Dermatology, Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul South Korea
| | - Ghee Young Kwon
- Department of Pathology, Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul South Korea
| | - Goo-Hyun Mun
- Department of Plastic Surgery, Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul South Korea
| | - Dong-Youn Lee
- Department of Dermatology, Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul South Korea
| | - Jason B. Lee
- Department of Dermatology and Cutaneous Biology; Thomas Jefferson University Hospital; Philadelphia PA USA
| | - Kelly K. Park
- Division of Dermatology; Loyola University Medical Center; Maywood IL USA
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Abstract
Nail disorders are a common presenting complaint for both the primary care physician and the dermatologist. Nail diagnoses are broad in scope and include infectious, inflammatory, and neoplastic conditions. Onychomycosis is an especially common nail condition, and treatment should always be preceded by appropriate fungal studies for confirmation of diagnosis. Inflammatory conditions of the nail unit can mimic onychomycosis, and a dermatologist can assist with diagnosis and treatment recommendations. Likewise, subungual tumors often require biopsy, and should be evaluated by a dermatologist who is experienced in nail evaluation and treatment.
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Affiliation(s)
- Lauren K Biesbroeck
- Division of Dermatology, University of Washington School of Medicine, 1959 Northeast Pacific Street, BB-1353, Box 356524, Seattle, WA 98195-6524, USA.
| | - Philip Fleckman
- Division of Dermatology, University of Washington School of Medicine, 1959 Northeast Pacific Street, BB-1353, Box 356524, Seattle, WA 98195-6524, USA
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Boni A, Chu EY, Rubin AI. Routine nail clipping leads to the diagnosis of amelanotic nail unit melanoma in a young construction worker. J Cutan Pathol 2015; 42:505-9. [PMID: 26272255 DOI: 10.1111/cup.12558] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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28
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Wang L, Gao T, Wang G. Invasive onychocytic carcinoma. J Cutan Pathol 2015; 42:361-7. [PMID: 25727336 DOI: 10.1111/cup.12476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 01/23/2015] [Accepted: 02/07/2015] [Indexed: 12/01/2022]
Abstract
Neoplasms originating from nail matrix keratinocytes are very rare. Onychomatricoma and onychocytic matricoma are benign tumors arising from nail matrix keratinocytes. Only one case of onychocytic carcinoma, the malignant counterpart of onychocytic matricoma, has been reported in the literature. Herein, we describe a case of invasive onychocytic carcinoma. Two biopsy specimens of the tumor, obtained at early and invasive stages, were examined histopathologically. The first biopsy specimen showed a retiform proliferation of eosinophilic and basophilic cells in the nail matrix. The second biopsy specimen showed a retiform basophilic cell proliferation with focal keratinization. Similar to normal nail matrix keratinocytes, the proliferating basophilic cells failed to express cytokeratin (CK)1, CK6 and CK10. Focal expression of hair-specific keratins, including K31, K85 and K86, was observed. On the basis of these findings, the tumor was identified as an invasive malignant tumor originating from nail matrix keratinocytes.
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Affiliation(s)
- Lei Wang
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xian, China
| | - Tianwen Gao
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xian, China
| | - Gang Wang
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xian, China
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Perrin C. The nail dermis: from microanatomy to constitutive modelling. Histopathology 2015; 66:864-72. [PMID: 25387989 DOI: 10.1111/his.12608] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 11/05/2014] [Indexed: 12/01/2022]
Abstract
AIMS The nail mesenchyme, as ligamentous connective tissue, is classically described as a single compartment. Some authors have even suggested the concept of the nail as a musculoskeletal appendage. Recent studies conducted on supernumerary digits surgically removed for polydactyly or on the developing nail organ have introduced into the literature a new concept: the onychodermis and its onychofibroblasts that are CD10-positive/CD34-negative. The aim of this study was to explore the nail mesenchyme more comprehensively. METHODS AND RESULTS A series of 10 normal adult nail units were examined with a combination of morphological and immunohistochemical analysis. This study demonstrates that the nail mesenchyme has two distinct compartments, with a complex microanatomy of matrical dermis and its hypoderm. The matrical dermis is a relatively independent substructure, and comprises two parts: a thin papillary dermis, and a relatively thick reticular dermis. The matrical hypoderm corresponds to a cushion-like layer of adipose tissue, which distally intermingles with an area of loose connective tissue. The nail bed dermis comprises a single, relatively homogeneous compartment. CONCLUSION The matrical nail mesenchyme is a modified dermis. The concept of onychodermis is not applicable in the normal adult nail. Underrecognized non-pathological structures may pose diagnostic problems. The chameleon matrical hypoderm is one such structure.
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Affiliation(s)
- Christophe Perrin
- Laboratoire Central d'Anatomie Pathologique, Hôpital L. Pasteur, University of Nice, Nice, France
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New described dermatological disorders. BIOMED RESEARCH INTERNATIONAL 2014; 2014:616973. [PMID: 25243162 PMCID: PMC4163364 DOI: 10.1155/2014/616973] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 07/02/2014] [Accepted: 08/07/2014] [Indexed: 11/18/2022]
Abstract
Many advances in dermatology have been made in recent years. In the present review article, newly described disorders from the last six years are presented in detail. We divided these reports into different sections, including syndromes, autoinflammatory diseases, tumors, and unclassified disease. Syndromes included are “circumferential skin creases Kunze type” and “unusual type of pachyonychia congenita or a new syndrome”; autoinflammatory diseases include “chronic atypical neutrophilic dermatosis with lipodystrophy and elevated temperature (CANDLE) syndrome,” “pyoderma gangrenosum, acne, and hidradenitis suppurativa (PASH) syndrome,” and “pyogenic arthritis, pyoderma gangrenosum, acne, and hidradenitis suppurativa (PAPASH) syndrome”; tumors include “acquired reactive digital fibroma,” “onychocytic matricoma and onychocytic carcinoma,” “infundibulocystic nail bed squamous cell carcinoma,” and “acral histiocytic nodules”; unclassified disorders include “saurian papulosis,” “symmetrical acrokeratoderma,” “confetti-like macular atrophy,” and “skin spicules,” “erythema papulosa semicircularis recidivans.”
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Löser C, Mayser PA. [Dark nail: clinical findings, diagnostics and therapy of melanonychia]. Hautarzt 2014; 65:327-36. [PMID: 24718509 DOI: 10.1007/s00105-013-2706-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND A dark colored pigmentation of nails can be due to a subungual malignant melanoma. There are, however, many other benign causes and this differentiation is an important challenge in dermatological practice. PROBLEM When should nail pigmentation be clarified by histological investigations? MATERIAL AND METHODS This article gives a survey of the literature on this topic and a review of own experiences with clinical case examples. The various causes of melanonychia are presented and criteria for the early recognition of melanoma of the nail matrix are formulated. RESULTS The width and depth of color of longitudinal melanonychia do not allow any conclusions on the dignity. If the nail striation is proximally broader than distally, this is evidence of a proliferative event. Confirmation of a subungual hemorrhage does not exclude a malignancy per se. Also detection of pigmentation due to fungi does not exclude the additional presence of a subungual melanoma. A systematic clinical analysis using clear criteria leads to a working diagnosis and suitable treatment. CONCLUSION An early and correct designation of nail pigmentation can avoid unnecessary nail interventions but can also be life saving.
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Affiliation(s)
- C Löser
- Hautklinik, Hauttumorzentrum, Klinikum der Stadt Ludwigshafen am Rhein gGmbH, Ludwigshafen, Deutschland
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