Nail matrix dermoscopy
Intraoperative non-contact polarized light dermoscopy of the nail matrix
With non-contact polarized light dermoscopy, it is possible to examine the nail matrix during the surgical biopsy procedure without risk of microbial contamination of either the exposed nail matrix or the sterile surgical instruments. In 2005 Hirata et al. proposed the perioperative examination of the nail matrix and described the streaks, pigment network and globules in the nail matrix and nail bed in conditions characterized by nail matrix melanocytic hyperplasia whereas diffuse homogeneous pigmentation was observed in conditions without prominent melanocytic hyperplasia of the nail matrix such as ethnic-type pigmentation, . Moreover, we consider that intraoperative dermoscopic examination of the nail bed and the nail matrix permits a more precise targeting of the biopsy than might occur with simple examination using the naked eye. This could also be applied in non-pigmented subungual tumors such as small squamous cell carcinoma, glomus cell tumor onychopapilloma or onychomatricoma. The same authors also proposed ex vivo dermoscopic examination of the nail matrix biopsy. This can be performed with contact immersion dermoscopy and provides much sharper images with similar observations.
We must add that ex vivo reflectance confocal microscopic examination is also possible and allows detailed visualization at the cellular level. Indeed, additional work is badly needed to evaluate ex vivo reflectance confocal microscopic examination of nail matrix pigmented tumors.
- Hirata SH, Yamada S, Almeida FA et al. (2006) Dermoscopic examination of the nail bed and matrix. Int J Dermatol 45(1): 28–30
- Hirata SH, Yamada S, Almeida FA et al. (2005) Dermoscopy of the nail bed and matrix to assess melanonychia striata. J Am Acad Dermatol 53(5): 884–6.
- Rai AK Role of intraoperative dermoscopy in excision of nail unit glomus tumor. Indian Dermatol Online J. 2016 Sep-Oct;7(5):448-450
- E. Ginoux, M. Perier Muzet, N. Poulalhon, S. Debarbieux, S. Dalle and L. Thomas Intraoperative dermoscopic features of onychomatricoma: a review of 10 cases in press clin exp dermatology 2017