Correlation of dermoscopic structures on nails

From dermoscopedia

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Diagnosisis the identification of the nature and cause of a certain phenomenon. Diagnosis is used in many different disciplines with variations in the use of logic, analytics, and experience to determine "cause and effect". In systems engineering and computer science, it is typically used to determine the causes of symptoms, mitigations, and solutions of pigmentation of the nail unit is challenging as the differential diagnosisis the identification of the nature and cause of a certain phenomenon. Diagnosis is used in many different disciplines with variations in the use of logic, analytics, and experience to determine "cause and effect". In systems engineering and computer science, it is typically used to determine the causes of symptoms, mitigations, and solutions is broad. It includes traumaThis glossary term has not yet been described., infectionThis glossary term has not yet been described., exogenous pigmentation and melanocyticThis glossary term has not yet been described. activation (lentigoThis glossary term has not yet been described., drug-induced, post inflammatory pigmentation) or proliferation (nevusThis glossary term has not yet been described., melanocytic hyperplasia or melanomaThis glossary term has not yet been described. (Alessandrini et al., 2017; Braun et al., 2007; “dermoscopediaDermoscopedia is the name of this website and is providing state of knowledge information concerning dermoscopy - a non invasive diagnostic method.,” n.d.).

Gray band

In pigmented nail bands (longitudinal melanonychia), the presence of gray granules within a gray band correlates with epithelial hyperpigmentation due to melanocytic activation.

Brown band

Brown/black granules within a brown or black band reveals on the histopathologic study a melanocytic proliferation (Braun et al., 2007).

Irregular brown band

In melanocytic proliferations, an irregular pigmented band originating from the proximal nail fold with multiple colorsThis glossary term has not yet been described., variable thickness of the lines and loss of parallelism is suggestive of nail apparatus melanoma (NAM) (Braun et al., 2007).

Micro-Hutchison’s sign

is the periungual skin pigmentation of hyponychium (pigmentation of the cuticle) evident only with dermoscopyThe examination of [skin lesions] with a 'dermatoscope'. This traditionally consists of a magnifier (typically x10), a non-polarised light source, a transparent plate and a liquid medium between the instrument and the skin, and allows inspection of skin lesions unobstructed by skin surface reflections. Modern dermatoscopes dispense with the use of liquid medium and instead use polarised light to cancel out skin surface reflections. (Braun et al., 2007). It is associated with NAM in adults and corresponds to the initial radial growth of melanoma into adjacent tissue. Histologically, it may reflect the Breslow index, as micro-Hutchinson sign has been seen associated with early melanoma (Starace et al., 2018).

Vascular polymorphism

showing different types of vesselsThis glossary term has not yet been described. on dermoscopy, reflects chaotic neoangiogenesis on histologyThis glossary term has not yet been described. and has been associated with the invasive stage of NAM (Starace et al., 2018)

Free edge dermoscopy

DermoscopyThe examination of [skin lesions] with a 'dermatoscope'. This traditionally consists of a magnifier (typically x10), a non-polarised light source, a transparent plate and a liquid medium between the instrument and the skin, and allows inspection of skin lesions unobstructed by skin surface reflections. Modern dermatoscopes dispense with the use of liquid medium and instead use polarised light to cancel out skin surface reflections. can also guide biopsy by evaluating the free edge of the nailThis glossary term has not yet been described., avoiding inadequate sampling and delayed diagnosis.

Pigmentation of the upper part of the nail´s free edge

correlates histologically with melanocytic proliferations located in the proximal portion of the nail matrixThis glossary term has not yet been described.. P

Pigmentation of the lower part of the nail´s free edge

correlates histologically with melanocytes proliferating distally in the nail matrix (Braun et al., 2006).

Intra operative in vivo dermoscopy of the nail matrix

Dermoscopy can be used as an intraoperative procedure to see the pattern of pigmentation of nail matrix and to select the most appropriate area to biopsy. Dermoscopy of the nail matrix reveals dermoscopic features not seen in the nail plate (Hirata et al., 2006, 2011). There are 4 dermoscopic patternsThis glossary term has not yet been described.:

Regular gray pattern (fine regular grayish linesstreaksThis glossary term has not yet been described.)

corresponding with pigmentation in the basal layer (melanocytic activation) and absence of melanocytic hyperplasia or nests. 

Regular brown pattern (regular brown lines)

that histologically corresponds to benign melanocytic hyperplasia with larger amount of melanin and absence of melanocytic nests. 

Regular brown pattern with globules or blotches

(regular longitudinal brown lines and presence of globules or blotches of regular size and distribution) is associated with melanocytic neviThis glossary term has not yet been described.. Histologically, the globules correlate with the presence of nests. The blotches correlate with the presence of large amounts of melanin.

Irregular pattern

(longitudinal lines of irregular color and thickness, with or without irregular globulesGlobules with variability in color, size, shape or spacing and distributed in an asymmetric fashion or blotches), histologically correspond to a disorganized proliferation of atypical melanocytes with atypical cell nests. The irregular lines reveal atypical melanocyte proliferation producing thick longitudinal lines with spread of the pigmentation to adjacent areas. The irregular pattern shows a high sensitivityThis glossary term has not yet been described. and specificityThis glossary term has not yet been described. for melanoma (Hirata et al., 2011).