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When all you have is a dermatoscope- start looking at the nails.

Haenssle HA, Blum A, Hofmann-Wellenhof R, Kreusch J, Stolz W, Argenziano G, Zalaudek I, Brehmer F - Dermatol Pract Concept (2014)

Bottom Line: The formation of continuous, longitudinal pigmented streaks (longitudinal melanonychia) may either be caused by a benign activation of matrix melanocytes (e.g., as a result of trauma, inflammation, or adverse drug reactions) or by a true melanocytic proliferation (e.g., in a nevus or melanoma).Important and common differential diagnoses in these cases are subungual hemorrhage or onychomycosis.Benign or malignant neoplasms that may also affect the nail unit include glomus tumor, Bowen's disease, squamous cell carcinoma, and rare collision tumors.

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany ; Department of Dermatology, Venereology and Allergology, University Medical Center Heidelberg, Heidelberg, Germany.

ABSTRACT
Pigmented and non-pigmented nail alterations are a frequent challenge for dermatologists. A profound knowledge of clinical and dermatoscopic features of nail disorders is crucial because a range of differential diagnoses and even potentially life-threatening diseases are possible underlying causes. Nail matrix melanocytes of unaffected individuals are in a dormant state, and, therefore, fingernails and toenails physiologically are non-pigmented. The formation of continuous, longitudinal pigmented streaks (longitudinal melanonychia) may either be caused by a benign activation of matrix melanocytes (e.g., as a result of trauma, inflammation, or adverse drug reactions) or by a true melanocytic proliferation (e.g., in a nevus or melanoma). In general, non-continuous nail alterations, affecting only limited parts of the nail apparatus, are most frequently of non-melanocytic origin. Important and common differential diagnoses in these cases are subungual hemorrhage or onychomycosis. In addition, foreign bodies, bacterial infections, traumatic injuries, or artificial discolorations of the nail unit may less frequently cause non-continuous nail alterations. Many systemic diseases that may also show involvement of the nails (e.g., psoriasis, atopic dermatitis, lichen planus, alopecia areata) tend to induce alterations in numerous if not all nails of the hands and feet. A similar extensive and generalized alteration of nails has been reported after treatment with a number of systemic drugs, especially antibiotics and cytostatics. Benign or malignant neoplasms that may also affect the nail unit include glomus tumor, Bowen's disease, squamous cell carcinoma, and rare collision tumors. This review aims to assist clinicians in correctly evaluating and diagnosing nail disorders with the help of dermatoscopy.

No MeSH data available.


Related in: MedlinePlus

Squamomelanocytic tumor of the nail unit as a genuine collision tumor of a squamous cell carcinoma and melanoma. (A) Overview. (B) Dermatoscopy. The nail unit is completely destroyed and shows yellowish keratotic as well as reddish erosive areas. Plugs of keratin (similar to the keratotic pseudocysts of a seborrheic keratosis) in the periungual skin may be considered a marker of a keratinizing tumor. The irregular gray-brown discoloration of the periungual skin corresponded to invasive melanoma cells in the histopathological evaluation. (Copyright: ©2014 Haenssle et al.; first published in Der Hautarzt, 2014, 65(4):301–11.)
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f14-dp0404a02: Squamomelanocytic tumor of the nail unit as a genuine collision tumor of a squamous cell carcinoma and melanoma. (A) Overview. (B) Dermatoscopy. The nail unit is completely destroyed and shows yellowish keratotic as well as reddish erosive areas. Plugs of keratin (similar to the keratotic pseudocysts of a seborrheic keratosis) in the periungual skin may be considered a marker of a keratinizing tumor. The irregular gray-brown discoloration of the periungual skin corresponded to invasive melanoma cells in the histopathological evaluation. (Copyright: ©2014 Haenssle et al.; first published in Der Hautarzt, 2014, 65(4):301–11.)

Mentions: A collision tumor is a cutaneous proliferation composed of closely intermingled cells of two independent tumor entities at the same location, e.g., of a melanoma and a squamous cell carcinoma. A squamomelanocytic tumor is such a collision tumor that mostly occurs in sun-exposed skin of the face and neck area of older patients [19,20]. Recently, a first squamomelanocytic tumor of the nail unit has been reported [21]. The clinical and dermatoscopic examination revealed an advanced dystrophy of the nail plate with brown to slate-gray periungual pigmentation (corresponding to invasive melanocytes of the melanoma) and several keratin cysts of the adjacent skin (corresponding to areas of keratinization of the squamous cell carcinoma) (Figure 14 A, B).


When all you have is a dermatoscope- start looking at the nails.

Haenssle HA, Blum A, Hofmann-Wellenhof R, Kreusch J, Stolz W, Argenziano G, Zalaudek I, Brehmer F - Dermatol Pract Concept (2014)

Squamomelanocytic tumor of the nail unit as a genuine collision tumor of a squamous cell carcinoma and melanoma. (A) Overview. (B) Dermatoscopy. The nail unit is completely destroyed and shows yellowish keratotic as well as reddish erosive areas. Plugs of keratin (similar to the keratotic pseudocysts of a seborrheic keratosis) in the periungual skin may be considered a marker of a keratinizing tumor. The irregular gray-brown discoloration of the periungual skin corresponded to invasive melanoma cells in the histopathological evaluation. (Copyright: ©2014 Haenssle et al.; first published in Der Hautarzt, 2014, 65(4):301–11.)
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4230252&req=5

f14-dp0404a02: Squamomelanocytic tumor of the nail unit as a genuine collision tumor of a squamous cell carcinoma and melanoma. (A) Overview. (B) Dermatoscopy. The nail unit is completely destroyed and shows yellowish keratotic as well as reddish erosive areas. Plugs of keratin (similar to the keratotic pseudocysts of a seborrheic keratosis) in the periungual skin may be considered a marker of a keratinizing tumor. The irregular gray-brown discoloration of the periungual skin corresponded to invasive melanoma cells in the histopathological evaluation. (Copyright: ©2014 Haenssle et al.; first published in Der Hautarzt, 2014, 65(4):301–11.)
Mentions: A collision tumor is a cutaneous proliferation composed of closely intermingled cells of two independent tumor entities at the same location, e.g., of a melanoma and a squamous cell carcinoma. A squamomelanocytic tumor is such a collision tumor that mostly occurs in sun-exposed skin of the face and neck area of older patients [19,20]. Recently, a first squamomelanocytic tumor of the nail unit has been reported [21]. The clinical and dermatoscopic examination revealed an advanced dystrophy of the nail plate with brown to slate-gray periungual pigmentation (corresponding to invasive melanocytes of the melanoma) and several keratin cysts of the adjacent skin (corresponding to areas of keratinization of the squamous cell carcinoma) (Figure 14 A, B).

Bottom Line: The formation of continuous, longitudinal pigmented streaks (longitudinal melanonychia) may either be caused by a benign activation of matrix melanocytes (e.g., as a result of trauma, inflammation, or adverse drug reactions) or by a true melanocytic proliferation (e.g., in a nevus or melanoma).Important and common differential diagnoses in these cases are subungual hemorrhage or onychomycosis.Benign or malignant neoplasms that may also affect the nail unit include glomus tumor, Bowen's disease, squamous cell carcinoma, and rare collision tumors.

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany ; Department of Dermatology, Venereology and Allergology, University Medical Center Heidelberg, Heidelberg, Germany.

ABSTRACT
Pigmented and non-pigmented nail alterations are a frequent challenge for dermatologists. A profound knowledge of clinical and dermatoscopic features of nail disorders is crucial because a range of differential diagnoses and even potentially life-threatening diseases are possible underlying causes. Nail matrix melanocytes of unaffected individuals are in a dormant state, and, therefore, fingernails and toenails physiologically are non-pigmented. The formation of continuous, longitudinal pigmented streaks (longitudinal melanonychia) may either be caused by a benign activation of matrix melanocytes (e.g., as a result of trauma, inflammation, or adverse drug reactions) or by a true melanocytic proliferation (e.g., in a nevus or melanoma). In general, non-continuous nail alterations, affecting only limited parts of the nail apparatus, are most frequently of non-melanocytic origin. Important and common differential diagnoses in these cases are subungual hemorrhage or onychomycosis. In addition, foreign bodies, bacterial infections, traumatic injuries, or artificial discolorations of the nail unit may less frequently cause non-continuous nail alterations. Many systemic diseases that may also show involvement of the nails (e.g., psoriasis, atopic dermatitis, lichen planus, alopecia areata) tend to induce alterations in numerous if not all nails of the hands and feet. A similar extensive and generalized alteration of nails has been reported after treatment with a number of systemic drugs, especially antibiotics and cytostatics. Benign or malignant neoplasms that may also affect the nail unit include glomus tumor, Bowen's disease, squamous cell carcinoma, and rare collision tumors. This review aims to assist clinicians in correctly evaluating and diagnosing nail disorders with the help of dermatoscopy.

No MeSH data available.


Related in: MedlinePlus