Skin Cancer and Related Lesions-Longitudinal Melonychia: Clinical evaluation and biopsy technique

Longitudinal Melonychia: Clinical evaluation and biopsy technique

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This article is about longitudinal melonychia, a condition characterized by brown streaks on the nailbed, which can be benign or a form of subungual melanoma. The diagnosis of subungual melanoma is often delayed, leading to a poorer prognosis. The article provides an update on the evaluation and biopsy technique for longitudinal melonychia. The differential diagnosis for pigmented lesions of the nail unit includes both benign and malignant conditions, and clinical evaluation is necessary to determine which lesions require biopsy. The article outlines an "ABCDEF" rule for evaluating pigmentation changes in the nails. Biopsy is performed as a longitudinal full-thickness excisional procedure, and the specimen should be evaluated by permanent section. Treatment for subungual melanoma includes excision with clear margins and may require amputation of the distal phalanx. Sentinel node biopsy is indicated in patients with invasive subungual melanomas and clinically normal regional nodal examinations. The article also includes a clinical case study and provides pearls and pitfalls for diagnosing and managing longitudinal melonychia.

Keywords

longitudinal melonychia

subungual melanoma

diagnosis

evaluation

biopsy technique

pigmented lesions

ABCDEF rule

treatment

amputation

sentinel node biopsy