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Melanonychia insights
Petrou, I., M.D. (2012). Melanonychia insights. Dermatology Times, 33(8), 42-43. Retrieved from http://search.proquest.com/docview/1220452128?accountid=36155
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Abstract (summary)
The evaluation of clinical features of suspect lesions and the implementation of diagnostic tools such as the ABCDEF rules and dermoscopy of the nail plate, nail matrix and nail bed
are all used to arrive at an accurate diagnosis, Dr. Di Chiacchio says. According to Dr. Di Chiacchio, histopathological examination of the nail matrix remains the gold standard to
diagnose early melanomas or benign melanocytic alterations.
Headnote
Brazilian dermatologist discusses success with tangential biopsy
Sao Paulo - A tangential biopsy performed on melanonychia may often be the superior biopsy technique in exacting an accurate diagnosis of suspect lesions, according to Nilton Di
Chiacchio, M.D., department of dermatology, Hospital of Public Service, Sao Paulo.
Melanonychia is a longitudinal or transverse black- or brownpigmented streak of the nail. Longitudinal melanonychias are of particular interest, Dr. Di Chiacchio says, because
although they may be due to several causes (including onychomycosis, hematoma following ungula trauma or nonmelanoma melanocytic tumors), they may also be a sign of
subungual melanoma or aerai lentiginous melanoma.
"An accurate assessment of melanonychia can be very challenging, even for experienced clinicians, and failure to make an accurate diagnosis could be catastrophic. The main
importance of melanonychias is that subungual melanoma may present itself as a pigmented streak of the nail, and therefore, accurate diagnosis of the suspect lesion is crucial,"
Dr. Di Chiacchio says.
The evaluation of clinical features of suspect lesions and the implementation of diagnostic tools such as the ABCDEF rules and dermoscopy of the nail plate, nail matrix and nail bed
are all used to arrive at an accurate diagnosis, Dr. Di Chiacchio says. However, the accuracy of the diagnosis of early melanomas with clinical appearance of melanonychias is still
low, regardless of the level of experience of the dermatologist.
Pilot study
Dr. Di Chiacchio recently conducted a pilot study to evaluate whether the tangential biopsy technique could help minimize nail plate dystrophy and prove the technique sufficient in
removing enough tissue for histological evaluation and the complete removal of lesions. The study included 22 subungual lesions by tangential nail matrix excision, including 14
hypermelanosis, one lentigo, six nevi and one melanoma in situ.
Dr. Di Chiacchio used intraoperative polarized dermoscopy during the procedure to determine the lateral margins of the lesion where the incisions were carried out. All specimens
were stained with H&E and evaluated by a dermatopathologist.
Results showed that the tangential biopsy technique was successful in removing sufficient tissue needed for a good histological diagnosis of lesions. A light nail plate dystrophy was
seen in just two cases.
"I believe that many dermatologists will just evaluate the clinical features and sometimes perform nail plate dermoscopy in suspicious-looking melanonychias, which in my opinion is
insufficient workup. In suspicious cases, excision biopsy of the pigmented lesion is mandatory," Dr. Di Chiacchio says.
Dermoscopy highlights
According to Dr. Di Chiacchio, intraoperative dermoscopy of the nail matrix and its bed is mandatory, particularly in suspicious lesions. In his technique, Dr. Di Chiacchio reclines the
proximal nail fold and detaches half of the proximal part of the nail plate, allowing for a direct view of the pigmented lesion with dermoscopy.
"We believe that tangential biopsy is a promising technique to remove benign pigmented lesions of the nail plate and that the amount of tissue removed is sufficient for a good
histological diagnosis," Dr. Di Chiacchio says. "However, the limitations of the technique include as experienced histological technician and dermatopathologist to follow the
specimen processing and evaluation."
According to Dr. Di Chiacchio, histopathological examination of the nail matrix remains the gold standard to diagnose early melanomas or benign melanocytic alterations. However,
the biopsy of the nail matrix with punch or elliptical excision has been avoided, he says, due to the possibility of nail plate dystrophy.
The shave biopsy, or tangential biopsy, allows for the complete removal of the pigmented lesion while helping to avoid nail plate dystrophy, he says.
"Among the many techniques that can be employed, the tangential biopsy of the matrix is an elegant alternative providing adequate samples for histopathologic analysis, as well as
excellent cosmetic results. In our experience, the tangential biopsy technique can offer the dermatopathologist ample tissue sample to arrive at an accurate diagnosis," Dr. Di
Chiacchio says.
Sidebar
A 12-year-old patient ") with a longitudinal > melanonychia of the J nail before the lesion is removed (left) via tangential excision (middle). The nail 18 months after tangential
excision of the pigmented lesion (right), without nail plate dystrophy. Histopathology confirmed the diagnosis of hypermelanosis.
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Indexing (details)
Subject Fingers & toes;
Medical disorders
Title Melanonychia insights
Author Petrou, Ilya, MD
Publication title Dermatology Times
Volume 33
Issue 8
Pages 42-43
Number of pages 2
Publication year 2012
Publication date Aug 2012
Year 2012
Section clinical dermatology
Publisher Advanstar Communications, Inc.
Place of publication North Olmsted
Country of publication United States
Publication subject Medical Sciences--Dermatology And Venereology
ISSN 01966197
CODEN DETIEG
Source type Trade Journals
Language of publication English
Document type Feature
Document feature Photographs
ProQuest document ID 1220452128
Document URL http://search.proquest.com/docview/1220452128?
accountid=36155
Copyright Copyright Advanstar Communications, Inc. Aug 2012
Last updated 2013-12-04
Database ProQuest Central
Copyright 2014 ProQuest LLC. All rights reserved. Terms and Conditions
QUICK READ
A tangential biopsy can often be the method of choice to exact an accurate diagnosis of melanonychia.
"An accurate assessment of melanonychia can be very challenging, even for experienced clinicians, and failure to make an accurate diagnosis could be catastrophic."
Nilton Di Chlacchio, M. D.
Sao Paulo
Sidebar
Disclosures: Dr. Di Chiacchio reports no relevant financial interests.
AuthorAffiliation
By llya Petrou, M.D.
Senior Staff Correspondent
Copyright Advanstar Communications, Inc. Aug 2012
Bibliography
Citation style: APA6
Petrou, I., M.D. (2012). Melanonychia insights. Dermatology Times, 33(8), 42-43. Retrieved from http://search.proquest.com/docview/1220452128?accountid=36155
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