Melanoma at nails

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 Authored by: Luc Thomas

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NailThis glossary term has not yet been described. matrix pigmented melanomaThis glossary term has not yet been described.

In cases of melanonychia striata in a postpuberty patient, melanoma should be included in 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 list[1]. Clinical warning signs are adult onset, monodactylic involvement, changes over time observed by the patient, triangular shape of the band (indicating that the lesion is growing relatively faster than the nailThis glossary term has not yet been described. plate), polychromia and the presence of pigmentation of the periungual skin (also known as Hutchinson’s sign). 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. provides useful additional information: the coloration of the background is light brown to black and the longitudinal dermoscopic micro-lines are irregular in their thickness, spacing and coloration and may show areas of parallelism disruption. Brown-to-black dots and globules may be observed in association with the longitudinal linesstreaksThis glossary term has not yet been described.. Dermoscopic examination of periungual skin may disclose a micro Hutchinson’s sign invisible to the naked eye. In cases of prominent periungual pigmentation, its dermoscopical features either produce a parallel ridge patternVolar pigmentation forming lines, parallel, diffuse and irregular, along the ridges or cristae superficiales (raised portion of the dermatoglyphics) on the pulp, the lateral aspects and/or distal aspects of the finger/toe or a diffuse irregular pigmentation on the supramatricial skinThis glossary term has not yet been described.. Careful attention must be paid to cases in which the irregular pattern of the lines is associated with subungual hemorrhageThis glossary term has not yet been described..

Nail matrix amelanotic melanomatype of skin cancer in which the cells do not make melanin

Amelanotic melanomatype of skin cancer in which the cells do not make melanin of the nail unit is very often a late presentationThis glossary term has not yet been described. of the disease after several months/years of the undiagnosed condition which often includes typical monodactylic melanonychia striata[2][3]. At this stage, partial or complete erosion of the nail plate is observed and the pigmentation that the patient eventually recalls having had has vanished, to be replaced by an often exophytic, ulcerative, bleeding tumor. Differential diagnosis includes pyogenic granulomaThis glossary term has not yet been described. and several infectiousThis glossary term has not yet been described. conditions but, as a rule, amelanotic melanoma should be systematically included in cases of monodactylic nail plate erosion with or without nodular and erosive tumor. In this case, 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. reveals features that have been described on amelanotic melanoma of the skin[4].

It shows an atypical vascular pattern characterized by the presence of linear and irregular vesselsThis glossary term has not yet been described., the presence of milky-red areas or the presence of three or more types of vessel types within the same lesion. In a few cases, only red spots seen through the nail plate or in areas of plate erosion are visible. It is also possible to identify subtle areas of pigmentation, invisible to the naked eye and incorrectly but traditionally called “remnants” of pigmentation.


ReferencesThis is material contained in a footnote or bibliography holding further information.
  1. Tosti A, Piraccini BM, de Farias DC. (2009) Dealing with melanonychia. Semin Cutan Med Surg 28(1): 49–54.
  2. Phan A, Touzet S, Dalle S, Ronger-Savlé S, Balme B, Thomas L. (2006) AcralPertaining to peripheral body parts, especially hands, feet, fingers, and toes. lentiginous melanoma: a clinicoprognostic study of 126 cases. Br J Dermatol 155(3): 561–9.
  3. Phan A, Touzet S, Dalle S, Ronger-Savlé S, Balme B, Thomas L. (2007) Acral lentiginous melanoma: histopathological prognostic features of 121 cases. Br J Dermatol 157(2): 311–18.
  4. Zalaudek I, Kreusch J, Giacomel J, Ferrara G, Catricalà C, Argenziano G. (2010) How toGives basic instructions and directions to someone on the methods for doing or making something. diagnose nonpigmented skin tumors: a review of vascular structuresThis glossary term has not yet been described. seen with dermoscopy: part I. MelanocyticThis glossary term has not yet been described. skin tumors. J Am Acad Dermatol 63(3): 361–74.