Journal of the American Academy of Dermatology
Volume 56, Issue 5 , Pages 803-810 , May 2007

Nail matrix biopsy of longitudinal melanonychia: Diagnostic algorithm including the matrix shave biopsy

  • Nathaniel Jellinek, MD

      Affiliations

    • Corresponding Author InformationReprint requests: Nathaniel Jellinek, MD, University Dermatology, 593 Eddy St, APC 10, Providence, RI, 01903.

References 

  1. Zook EG, Baran R, Haneke E, Dawber RPR. Nail surgery and traumatic abnormalities. In:  Baran R,  Dawber RPR,  de Berker DAR, et al. editor. Baran and Dawber's Diseases of the nails and their management. 3rd ed.. Malden (MA): Blackwell Science; 2001;p. 425–514
  2. Rich P. Nail biopsy. Indications and methods. J Dermatol Surg Oncol. 1992;18:673–682
  3. De Berker D, Mawhinney B, Sviland L. Quantification of regional matrix nail production. Br J Dermatol. 1996;134:1083–1086
  4. De Berker D, Wojnarowska F, Sviland L, Westgate GE, Dawber RP, Leigh IM. Keratin expression in the normal nail unit: markers of regional differentiation. Br J Dermatol. 2000;142:89–96
  5. Krull EA. Longitudinal melanonychia. In:  Krull EA,  Zook EG,  Baran R,  Haneke E editor. Nail surgery: a text and atlas. Philadelphia: Lippincott Williams & Wilkins; 2001;p. 239–274
  6. de Berker DA. Lateral longitudinal nail biopsy. Australas J Dermatol. 2001;42:142–144
  7. Rich P. Nail biopsy: indications and methods. Dermatol Surg. 2001;27:229–234
  8. De Berker DA, Baran R. Acquired malalignment: a complication of lateral longitudinal nail biopsy. Acta Derm Venereol. 1998;78:468–470
  9. Moossavi M, Scher RK. Complications of nail surgery: a review of the literature. Dermatol Surg. 2001;27:225–228
  10. Krull EA. Biopsy techniques. In:  Krull EA,  Zook EG,  Baran R,  Haneke E editor. Nail surgery: a text and atlas. Philadelphia: Lippincott Williams & Wilkins; 2001;p. 55–88
  11. Abimelec P, Dumontier C. Basic and advanced nail surgery (Part 1: Principles and techniques). In:  Scher RK,  Daniel CR editor. Nails: diagnosis, therapy, surgery. 3rd ed.. Philadelphia: Elsevier Saunders; 2005;p. 265–289
  12. Haneke E, Baran R. Longitudinal melanonychia. Dermatol Surg. 2001;27:580–584
  13. Baran R, Kechijian P. Longitudinal melanonychia (melanonychia striata): diagnosis and management. J Am Acad Dermatol. 1989;21:1165–1175
  14. Andre J, Goettman-Bonvallot S. Longitudinal melanonychia. J Am Acad Dermatol. 2003;49:776
  15. Jellinek NJ. Primary malignant tumors of the nail unit. Adv Dermatol. 2005;21:33–64
  16. Tomizawa K. Early malignant melanoma manifested as longitudinal melanonychia: subungual melanoma may arise from suprabasal melanocytes. Br J Dermatol. 2000;143:431–434
  17. Goettmann-Bonvallet S, Andre J, Belaich S. Longitudinal melanonychia in children: a clinical and histopathologic study of 40 cases. J Am Acad Dermatol. 1999;41:17–22
  18. Haas N, Henz BM. Pitfall in pigmentation: pseudopods in the nail plate. Dermatol Surg. 2002;28:966–967
  19. Johr RH, Izakovic J. Dermatoscopy/ELM for the evaluation of nail-apparatus pigmentation. Dermatol Surg. 2001;27:315–322
  20. Kawabata Y, Ohara K, Hino H, Tamaki K. Two kinds of Hutchinson's sign, benign and malignant. J Am Acad Dermatol. 2001;44:305–307
  21. Ronger S, Touzet S, Ligeron C, Balme B, Viallard AM, Barrut D, et al. Dermoscopic examination of nail pigmentation. Arch Dermatol. 2002;138:1327–1333
  22. Tosti A, Argenziano G. Dermoscopy allows better management of nail pigmentation. Arch Dermatol. 2002;138:1369–1370
  23. Hirata SH, Yamada S, Almeida FA, Enokihara MY, Rosa IP, Enokihara MM, et al. Dermoscopic examination of the nail bed and matrix. Int J Dermatol. 2006;45:28–30
  24. Hirata SH, Yamada S, Almeida FA, Tomomori-Yamashita J, Enokihara MY, Paschoal FM, et al. Dermoscopy of the nail bed and matrix to assess melanonychia striata. J Am Acad Dermatol. 2005;53:884–886
  25. Gewirtzman AJ, Saurat JH, Braun RP. An evaluation of dermoscopy fluids and application techniques. Br J Dermatol. 2003;149:59–63
  26. Braun RP, Baran R, Saurat JH, Thomas L. Surgical Pearl: Dermoscopy of the free edge of the nail to determine the level of nail plate pigmentation and the location of its probable origin in the proximal or distal nail matrix. J Am Acad Dermatol. 2006;55:512–513
  27. Perrin C, Michiels JF, Pisani A, Ortonne JP. Anatomic distribution of melanocytes in normal nail unit: an immunohistochemical investigation. Am J Dermatopathol. 1997;19:462–467
  28. Husain S, Scher RK, Silvers DN, Ackerman AB. Melanotic macule of nail unit and its clinicopathologic spectrum. J Am Acad Dermatol. 2006;54:664–667
  29. Denkler K. A comprehensive review of epinephrine in the finger: to do or not to do. Plast Reconstr Surg. 2001;108:114–124
  30. Krunic AL, Wang LC, Soltani K, Weitzul S, Taylor RS. Digital anesthesia with epinephrine: an old myth revisited. J Am Acad Dermatol. 2004;51:755–759
  31. Wilhelmi BJ, Blackwell SJ, Miller JH, Mancoll JS, Dardano T, Tran A, et al. Do not use epinephrine in digital blocks: myth or truth?. Plast Reconstr Surg. 2001;107:393–397
  32. Richert B. Surgery of nail melanoma. San Francisco (CA): Council for Nail Disorders; 2006;
  33. Baran R, Kechijian P. Hutchinson's sign: a reappraisal. J Am Acad Dermatol. 1996;34:87–90
  34. Scher RK. Biopsy of the matrix of a nail. J Dermatol Surg Oncol. 1980;6:19–21
  35. High WA, Quirey RA, Guillen DR, Munoz G, Taylor RS. Presentation, histopathologic findings, and clinical outcomes in 7 cases of melanoma in situ of the nail unit. Arch Dermatol. 2004;140:1102–1106
  36. Brodland DG. The treatment of nail apparatus melanoma with Mohs micrographic surgery. Dermatol Surg. 2001;27:269–273
  37. Banfield CC, Dawber RP, Walker NP, Stables GI, Zeina B, Schomberg K. Mohs micrographic surgery for the treatment of in situ nail apparatus melanoma: a case report. J Am Acad Dermatol. 1999;40:98–99
  38. Finley RK, Driscoll DL, Blumenson LE, Karakousis CP. Subungual melanoma: an eighteen-year review. Surgery. 1994;116:96–100
  39. Brochez L, Verhaeghe E, Sales F, Del Marmol V, Deraemaecker R, Vossaert K, et al. Current guidelines in melanoma treatment. Melanoma Working Group of Gent and Bordet. Dermatology. 2000;200:160–166
  40. O'Leary JA, Berend KR, Johnson JL, Levin LS, Seigler HF. Subungual melanoma. A review of 93 cases with identification of prognostic variables. Clin Orthop Relat Res. 2000;378:206–212
  41. Wagner JD, Gordon MS, Chuang TY, Coleman JJ. Current therapy of cutaneous melanoma. Plast Reconstr Surg. 2000;105:1774–1799quiz 1800-1
  42. Park KG, Blessing K, Kernohan NM. Surgical aspects of subungual malignant melanomas. The Scottish Melanoma Group. Ann Surg. 1992;216:692–695
  43. Heaton KM, el-Naggar A, Ensign LG, Ross MI, Balch CM. Surgical management and prognostic factors in patients with subungual melanoma. Ann Surg. 1994;219:197–204
  44. Glat PM, Shapiro RL, Roses DF, Harris MN, Grossman JA. Management considerations for melanonychia striata and melanoma of the hand. Hand Clin. 1995;11:183–189
  45. National Comprehensive Cancer Network. Melanoma: treatment guidelines for patients. 2005.
  46. Roberts DL, Anstey AV, Barlow RJ, Cox NH, Newton Bishop JA, Corrie PG, et al. U.K. guidelines for the management of cutaneous melanoma. Br J Dermatol. 2002;146:7–17
  47. Clinical practice guidelines for the management of cutaneous melanoma. In: National Health and Medical Research Council, 1999. Available at: http://www.nhmrc.gov.au/publications/_files/cp68.pdf. Accessed January 2, 2007.
  48. Banfield CC, Dawber RP. Nail melanoma: a review of the literature with recommendations to improve patient management. Br J Dermatol. 1999;141:628–632

 Funding sources: None.Conflict of interest: None declared.

PII: S0190-9622(06)04101-6

doi: 10.1016/j.jaad.2006.12.001

Journal of the American Academy of Dermatology
Volume 56, Issue 5 , Pages 803-810 , May 2007