Nail plate dermoscopy

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 Editor: Luc Thomas

 Author(s): Luc Thomas     ·  Amélie Boespflug

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Examination of the nail plate free edge permits the observation of subungual localized hyperkeratosis in epithelial tumors of the nail matrixThis glossary term has not yet been described. such as Bowenalso known as squamous cell carcinoma in situ[1] is a neoplastic skin disease. It can be considered as an early stage or intraepidermal form of squamous cell carcinoma. It was named after John T. Bowen disease, squamous cell carcinomaThis glossary term has not yet been described., onychopapillomaThis glossary term has not yet been described., onychomatricomaThis glossary term has not yet been described. and seborrheic keratosisThis glossary term has not yet been described.. In onychomatricoma, its remarkable “dotted” free edge surface constitutes another criterion in favor of this 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. In onychopapilloma, the sharp “spine-shaped” hyperkeratotic plug visible underneath the nail plate in the area of nail changes is also very helpful.

It is also of interest to dermoscopically examine the distal free edge of the nail plate in cases of melanonychia striata since the position of the pigment in the nail plate gives an interesting indication of the location of the pigmented lesion with the matrix (i.e. proximal versus distal matrix). Since the dorsal aspect of the nail plate is derived from the proximal matrix, the presence of the pigment in the upper part of the nail plate free edge will indicate the site of the causal lesion in the proximal part of the matrix. In contrast, the presence of pigment in the lower part of the nail plate will favor a distal matrix location of the causative lesion. Knowing or estimating the location of a pigmented lesion preoperatively is of tremendous importance in order to inform the patient of the possible esthetic consequences of the biopsy. A biopsy taken from the distal matrix will create a nail plate with an almost invisible defect from underneath whereas a biopsy of the proximal matrix will cause a visible defect of the nail plate surface.