Nail apparatus melanoma: a diagnostic opportunity.
Bottom Line: The involvement of the nail apparatus is rare, with only 2 out of 3 patients seeking medical attention as the result of recent nail melanocytic lesions.This results in late diagnosis and a prognosis worse than cutaneous melanoma.The incidental diagnosis of nail melanoma in situ in our case significantly impacted the patient's survival.
Affiliation: UFAM, Manaus, AM, Brazil.
Malignant Melanoma is a high mortality neoplasm. The involvement of the nail apparatus is rare, with only 2 out of 3 patients seeking medical attention as the result of recent nail melanocytic lesions. This results in late diagnosis and a prognosis worse than cutaneous melanoma. We report a female, presenting with ulcerative lesions with clinical and laboratory features compatible with leishmaniasis. On return after treatment initiation a longitudinal melanonychia was observed on her first right finger. Biopsy of the nail matrix was performed. Histopathology was compatible with melanoma in situ. Longitudinal melanonychia is not a specific sign for melanoma and it is important that the dermatologist should identify the suspect lesions correctly. The incidental diagnosis of nail melanoma in situ in our case significantly impacted the patient's survival.
Related in: MedlinePlus
Mentions: 17-year-old female student from Manaus (Amazonas State), Fitzpatrick's phototype III,presented at the dermatology clinic with two ulcerated lesions. These were consistentwith leishmaniasis, both clinically and by lab (presence of Leshmaniasp. amatigotes pattern on direct examination). Pentavalent antimonial wasprescribed. During clinic follow-up, it was noted that the patient had a longitudinalmelanonychia on the right thumb (Figure 1). Onquestioning, she informed that this had been present for approximately one year. Shealso reported family history of melanoma (great-aunt). Dermatoscopic examinationrevealed lines varying in color from light brown to black, with different sizes, widthand distances, with the most proximal area being more intense and thicker than thedistal area, forming a triangular shape (Figure2). Ungual matrix biopsy was performed by shaving. Histopathology was compatiblewith melanoma in situ (Figure 3).Surgical management involved excision of ungual apparatus up to periosteal region.Following histopathology no neoplasm showed in the 40 cuts made. Clinical staging wasTisN0M0 (Stage 0). Patient followed up for 11 months without recurrence (Figure 4).