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Biopsy good choice for diagnosing melanonychia striata
Bowser, A. (1998). Biopsy good choice for diagnosing melanonychia striata. Dermatology Times, 19(6), 25-26. Retrieved from http://search.proquest.com/docview/231103632?
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Abstract (summary)
Although histologic data on melanonychia striata can be difficult to interpret, a biopsy is still a good bet for diagnosis of pigment in the nail unit. Other factors, such as race,
occurrence site, and clinical appearance can help narrow the diagnosis.
Headnote
Other clinical factors also may influence your decision
NEW YORK-Although histologic data on melanonychia striata can be difficult to interpret, a biopsy is still a good bet for diagnosis of pigment in the nail unit, according to Richard K
Scher, MD.
"We may be doing too many biopsies, but most of the time this is not known until after the final report is received," he said.
Dr. Scher, who has described melanonychia striata as "probably the most difficult clinical situation I face when seeing nail patients all day," advised dermatologists that biopsy of
the pigmented streak should be taken from the nail matrix. Taking a biopsy from the nail bed is usually of no diagnostic value, he said.
Consider These Factors
Making a diagnosis of the condition is difficult, especially because histologic reports often can be interpreted in more than one way. Other factors, such as race, occurrence site,
clinical appearance, and Hutchinson's sign, can help narrow the diagnosis, said Dr. Scher, who is professor of clinical dermatology at Columbia University College of Physicians and
Surgeons in New York City.
Race. "These pigmented bands may be normal in black patients and may be a normal variant in some Asians, but they probably are not normal in Caucasian patients," he noted.
Melanonychia striata reportedly occurs in about 1% of the white population. Melanoma related to the condition is less common in blacks, yet occurrence rates for the pigmented
bands are higher: 2.5% for blacks from 0 to 3 years of age, 70% for those more than 20, and 96% for those more than 50. These prevalence figures for blacks are probably too
high, believes Dr. Scher, and they vary depending on whether the individual is lightskinned or dark-skinned.
Occurrence site. Melanonychia striata appears most often in the thumb and great toe, and most cases that progress to melanoma occur in those two digits.
Clinical appearance. Other factors that could indicate trouble include very dark pigmentation, bands that are streaky and nonhomogeneous in appearance, a history of recent
change, involvement of a single nail, and sudden appearance in an older patient.
Hutchinson's sign. A cancerous lesion could be marked by Hutchinson's sign, a periungual extension of pigment to the proximal and lateral nail folds. This is an important-but not
infallible-indicator of subungual melanoma. "It's a very tricky area," Dr. Scher noted.
For instance, he presented the case of a 2-year-old child with a wide pigmented band, a great deal of streaking, and a suggestion of pigmentation of the nail fold. Biopsy revealed
that the pigment was a nevus.
Conversely, a 12-year-old patient had full pigment of the entire nail plate, making it impossible to look for Hutchinson's sign. Biopsy showed in situ melanoma.
Dr. Scher also described a black man who had pigmentation in several nails as well as onychomycosis. Oral antifungals cleared the subungual hyperkeratosis, so that the pigment
became even more noticeable. A biopsy revealed melanoma.
Some factors may help the dermatologist rule out less serious varieties of melanonychia striata. For example, medications, including azidothymidine and minocycline HCl, can cause
significant nail pigmentation, and certain systemic diseases may account for pigmentation as well.
Unanswered Questions
For lesions in adults, paradigms are emerging to determine which lesions to biopsy and which to remove following biopsy, reported Dr. Scher. However, to excise or not to excise in
children remains a difficult clinical question, with current opinion leaning away from surgery. "The final opinions are not yet in on this subject," Dr. Scher pointed out.
Based on eight white children who have longitudinal melanonychia, a 1996 Archives of Dermatology study concluded that the pigmentation should not be excised on grounds
different from those for other congenital or acquired nevi. There is not yet, however, unanimity of opinion on this concept.
Melanonychia striata research should be geared toward developing reliable histologic and clinical criteria to determine the probability of melanoma, he added. "We do not yet have
either with clear-cut consistency."
Copyright Advanstar Communications, Inc. Jun 1998
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Indexing (details)
Subject Medical diagnosis;
Dermatology;
Medical disorders;
Biopsy
Title Biopsy good choice for diagnosing melanonychia striata
Author Bowser, Andrew
Publication title Dermatology Times
Volume 19
Issue 6
Pages 25-26
Number of pages 2
Publication year 1998
Publication date Jun 1998
Year 1998
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
Accession number 03815962
ProQuest document ID 231103632
Document URL http://search.proquest.com/docview/231103632?
accountid=36155
Copyright Copyright Advanstar Communications, Inc. Jun 1998
Last updated 2013-12-04
Database ProQuest Central
Copyright 2014 ProQuest LLC. All rights reserved. Terms and Conditions
Bibliography
Citation style: APA6
Bowser, A. (1998). Biopsy good choice for diagnosing melanonychia striata. Dermatology Times, 19(6), 25-26. Retrieved from http://search.proquest.com/docview/231103632?
accountid=36155

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