Limits...
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

Early invasive subungual melanoma, thickness 0.2 mm. (A) Overview. (B) Dermatoscopy. Dermatoscopically, a homogeneous gray-brown band is visible, measuring approximately 6 mm across and continuously affecting the whole nail (longitudinal melanonychia). Sharply demarcated globular structures correspond to drop-like subungual hemorrhage. The macro-Hutchinson sign, being indicative of an invasion of melanoma cells into the periungual skin, is (still) negative (proximal nail fold). (Copyright: ©2014 Haenssle et al.)
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC4230252&req=5

f21-dp0404a02: Early invasive subungual melanoma, thickness 0.2 mm. (A) Overview. (B) Dermatoscopy. Dermatoscopically, a homogeneous gray-brown band is visible, measuring approximately 6 mm across and continuously affecting the whole nail (longitudinal melanonychia). Sharply demarcated globular structures correspond to drop-like subungual hemorrhage. The macro-Hutchinson sign, being indicative of an invasion of melanoma cells into the periungual skin, is (still) negative (proximal nail fold). (Copyright: ©2014 Haenssle et al.)

Mentions: In epidemiological studies, melanoma of the nail unit frequently appeared in patients older than 50 years and, interestingly, was mostly localized at the nail unit of the thumb or the great toe. Approximately 50% of patients with nail melanoma recollect a preceding trauma [3]. The width of the longitudinal pigmentation in melanoma in situ or early invasive melanoma frequently measures more than 5 mm and shows lines of variable thicknesses, spacing, and coloration [3,7,8]. A feature significantly associated with the diagnosis of subungual melanoma is the micro- or macro-Hutchinson sign defined by the visibility of a pigmentation of the periungual cuticula only by dermatoscopy or by naked eye inspection respectively (Figure 20A, B) [29]. Of note, in a number of early invasive subungual melanomas specific criteria may still be absent. In these cases a thorough investigation of the lesional evolution may raise enough suspicion to schedule a matrix biopsy (Figure 21A, B). For other cases, sequential digital dermatoscopy may help to detect dynamic changes in color as well as an increase in width of the whole longitudinal pigmentation over the course of time.


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)

Early invasive subungual melanoma, thickness 0.2 mm. (A) Overview. (B) Dermatoscopy. Dermatoscopically, a homogeneous gray-brown band is visible, measuring approximately 6 mm across and continuously affecting the whole nail (longitudinal melanonychia). Sharply demarcated globular structures correspond to drop-like subungual hemorrhage. The macro-Hutchinson sign, being indicative of an invasion of melanoma cells into the periungual skin, is (still) negative (proximal nail fold). (Copyright: ©2014 Haenssle et al.)
© Copyright Policy
Related In: Results  -  Collection

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

f21-dp0404a02: Early invasive subungual melanoma, thickness 0.2 mm. (A) Overview. (B) Dermatoscopy. Dermatoscopically, a homogeneous gray-brown band is visible, measuring approximately 6 mm across and continuously affecting the whole nail (longitudinal melanonychia). Sharply demarcated globular structures correspond to drop-like subungual hemorrhage. The macro-Hutchinson sign, being indicative of an invasion of melanoma cells into the periungual skin, is (still) negative (proximal nail fold). (Copyright: ©2014 Haenssle et al.)
Mentions: In epidemiological studies, melanoma of the nail unit frequently appeared in patients older than 50 years and, interestingly, was mostly localized at the nail unit of the thumb or the great toe. Approximately 50% of patients with nail melanoma recollect a preceding trauma [3]. The width of the longitudinal pigmentation in melanoma in situ or early invasive melanoma frequently measures more than 5 mm and shows lines of variable thicknesses, spacing, and coloration [3,7,8]. A feature significantly associated with the diagnosis of subungual melanoma is the micro- or macro-Hutchinson sign defined by the visibility of a pigmentation of the periungual cuticula only by dermatoscopy or by naked eye inspection respectively (Figure 20A, B) [29]. Of note, in a number of early invasive subungual melanomas specific criteria may still be absent. In these cases a thorough investigation of the lesional evolution may raise enough suspicion to schedule a matrix biopsy (Figure 21A, B). For other cases, sequential digital dermatoscopy may help to detect dynamic changes in color as well as an increase in width of the whole longitudinal pigmentation over the course of time.

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