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Subject Skin cancer
Title Melanonychia: A Question of Density
Author Selim, Angelica
Publication title Journal Watch. Dermatology
Publication year 2008
Publication date Aug 8, 2008
Year 2008
Publisher Massachusetts Medical Society
Place of publication Waltham
Country of publication United States
Publication subject Medical Sciences--Dermatology And
Venereology
ISSN 15213595
Source type Scholarly Journals
Language of publication English
Document type News
DOI http://dx.doi.org/10.1056/JD200808080000001
ProQuest document ID 1284416346
Document URL http://search.proquest.com/docview/1284416346?
accountid=36155
Copyright Copyright 2008 Massachusetts Medical Society. All
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reserved.
Last updated 2013-11-05
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Melanonychia: A Question of DensitySelim, A. (2008).
Melanonychia: A question of density. Journal Watch.Dermatology,
doi:http://dx.doi.org/10.1056/JD200808080000001
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Abstract (summary)
The most reliable histologic factor for distinguishing benign
subungual pigmented lesions from melanoma was the number of
melanocytes per millimeter.
Melanonychia is nail pigmentation from melanin deposition. When
it occurs in bands, it is called melanonychia longitudina (ML) or
melanonychia striata, and it can be formed of
melanotic macules, lentigines, nevi, or malignant melanoma (MM).
These authors sought histologic characteristics that distinguish
benign subungual ML from malignant junctional
melanomas. They compared density of melanocytes, the presence of
multinucleated cells, pagetoid spread, cytologic atypia,
inflammation, and the distribution of melanin pigment
in biopsy samples and excisions from 15 benign MLs, 20 subungual
MMs (10 in situ and 10 invasive), and 10 controls with non-ML nail
conditions.
Most of the patients were women (mean ages: 46 in the benign ML
group; 60 in the in-situ MM group; and 65 in the invasive MM
group). Thumbs and great toes were the most
common sites. In the control group, the density of melanocytes
was low (4-9 melanocytes per mm), and the melanocytes were present
at the basal and suprabasal levels. In the
benign ML group, the mean melanocytic concentration was 15.3
cells per mm; none of these lesions were confluent or
multinucleated. Focal pagetoid spread occurred in about half
the ML lesions. Atypia was mild or nonexistent. In the MM group,
the mean melanocytic concentrations in the in situ and invasive MM
groups were 58.9 per mm and 102.0 per mm,
respectively. Confluence was apparent in all MM lesions.
Pagetoid spread was also seen in all lesions, but florid pagetoid
spread increased from 20% in in situ MM to 70% in invasive
lesions. Most MM lesions were moderately atypical.
Comment:Nail pigmentation can represent keratinocytic or
melanocytic proliferations or infection. Certain clinical signs and
dermoscopic findings point to the lesion type, but
histology of the matrix and nail bed is critical for diagnosis.
Nearly two thirds of single MLs in adults are just increased
melanin pigment without melanocyte proliferation. However,
most longitudinal melanonychias in children are nevi, of which a
reported 30% are benign subungual melanonychia. These findings
highlight the importance of melanocytic density
as one of the earliest and most reliable clues to potentially
aggressive lesions. Severe atypia is unusual in these lesions, and
the implication of pagetoid spread needs to be
cautiously weighed, as it can occur in normal melanocytic
distribution.
Credit: Angelica Selim, MD
References
Amin B et al. Histologic distinction between subungual lentigo
and melanoma. Am J Surg Pathol 2008 Jun; 32:835.
Copyright 2008 Massachusetts Medical Society. All rights
reserved.
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