ABSTRACT
El síndrome de Laugier-Hunziker (SLH) es un trastorno de hiperpigmentación macular benigno adquirido que se caracteriza por la presencia de máculas hiperpigmentadas policrómicas, de superficie plana, con morfología lenticular oval, de márgenes definidos; parte importante de éste es el desarrollo de melanoniquia longitudinal. Su principal diagnóstico diferencial es el síndrome de Peutz-Jeghers, ya que este último tiende a desarrollar neoplasias malignas en el tracto digestivo. Es importante que el estomatólogo conozca el SLH, con la finalidad de poder diagnosticarlo y diferenciarlo de otras entidades, particularmente de aquellas de carácter maligno (AU)
Laugier-Hunziker syndrome (LHS) is an acquired benign macular hyperpigmentation disorder, characterized by the presence of polychromic hyperpigmented macules, with a smooth surface, with oval lenticular morphology, with defined margins; An important part of this is the development of longitudinal melanonychia. Its main differential diagnosis is Peutz-Jeghers syndrome, since it tends to develop malignant neoplasms in the digestive tract. It is important that the Stomatologist knows the LHS, in order to be able to diagnose it and differentiate it from other entities, even those of a malignant nature (AU)
Subject(s)
Humans , Female , Middle Aged , Pigmentation Disorders , Hyperpigmentation , Diagnosis, Differential , Mexico , Mouth Mucosa/injuriesABSTRACT
Objective:To investigate dermoscopic manifestations and features of melanonychia.Methods:A retrospective analysis was carried out on dermoscopic images of 4 common types of melanonychia collected in Department of Dermatology, Xijing Hospital, the Fourth Military Medical University from January 2016 to July 2020.Results:A total of 266 cases of melanonychia were collected, including 64 (24.1%) of subungual melanoma, 52 (19.5%) of nail matrix nevi, 89 (33.5%) of subungual hemorrhage, and 61 (22.9%) of onychomycosis. Subungual melanoma and nail matrix nevi mostly occurred in the fingernails. To be specific, subungual melanoma most frequently occurred in the thumbnails (62.8%) , while nail matrix nevi mostly involved the 2 nd - 5 th fingernails (73.9%) . Subungual hemorrhage and onychomycosis mostly occurred in the toenails, and there were 51 (57.3%) cases of subungual hemorrhage of the toenails and 46 (75.4%) cases of onychomycosis of the toenails. Subungual melanoma mostly occurred in patients aged over 40 years (49 cases, 76.8%) , while the other 3 types of melanonychia mostly affected patients aged under 40 years. Dermoscopic manifestations of subungual melanoma mainly included regular longitudinal bands (35 cases, 54.7%) or irregular bands (25 cases, 39.0%) whose width was greater than 3 mm in 87.5% cases, Hutchinson sign (36 cases, 56.3%) , and ruptures (15 cases, 23.4%) which mainly were black-brown in color; dermoscopic manifestations of nail matrix nevi mainly were a single regular pigmented band (52 cases, 100%) whose width was less than 3 mm in 36 (69.2%) cases, and Hutchinson sign (26 cases, 50%) , while no ruptures were observed in nail matrix nevus lesions; subungual hemorrhage dermoscopically manifested as diffuse macules (74 cases, 83.1%) , and globular dark red or black hemorrhagic structures were observed in 85 (95.5%) cases; fungal melanonychia was dermoscopically characterized by irregular dark brown longitudinal bands (54 cases, 88.5%) . Conclusions:Subungual melanoma was dermoscopically characterized by regular longitudinal bands with a width of greater than 3 mm, nail matrix nevi by regular longitudinal bands, subungual hemorrhage by diffuse macules, and onychomycosis by irregular longitudinal bands. Dermatoscopy can be used to identify melanonychia lesions and provide a basis for auxiliary diagnosis of subungual melanoma.
ABSTRACT
BACKGROUND: Longitudinal melanonychia (LM) can be challenging as it may be caused by a wide variety of benign and malignant conditions. However, there are scarce data on LM confirmed by skin biopsy examination in Korean patients. OBJECTIVE: We sought to evaluate the clinical features and histopathologic diagnosis of LM in Korean patients. METHODS: We reviewed the medical records and clinical photographs of patients presenting with LM confirmed by skin biopsy examination between June 2007 and June 2017. RESULTS: Among a total of 75 patients with LM confirmed by skin biopsy examination at our hospital over a period of 10 years, 11 patients (14.7%) had malignant lesions. Common features of malignant lesions were involvement of a single nail, color heterogeneity, Hutchinson's sign, and nail plate dystrophy or ulceration. Common features of benign lesions were a negative Hutchinson's sign and absence of nail plate dystrophy and ulceration. CONCLUSION: This study analyzed the clinical features and histopathologic diagnosis of LM in Korean patients. Our data may contribute to determining the management approach for patients with LM.
Subject(s)
Humans , Biopsy , Diagnosis , Medical Records , Population Characteristics , Skin , UlcerABSTRACT
Nail unit melanoma is a type of acral lentiginous melanoma and requires histopathologic examination for a confirmed diagnosis. However, inadequate biopsy techniques make definitive diagnosis difficult. A 61-year-old man presented with progressive nail pigmentation for 15 years, which was clinically highly suspicious for malignancy. Acral lentiginous melanoma was not detected in punch and longitudinal biopsy specimens, but en bloc excision tissue revealed melanoma. Acral lentiginous melanoma is known to have a heterogeneous pathologic manifestation depending on the pigmented region and the time it takes to progress. In this regard, en bloc excision can be considered as a first-line biopsy technique to diagnose acral lentiginous melanoma, indolent subtype.
Subject(s)
Humans , Middle Aged , Biopsy , Diagnosis , Melanoma , PigmentationABSTRACT
El síndrome de Laugier-Hunziker es un trastorno pigmentario adquirido poco frecuente, caracterizado por presentar lesiones hiperpigmentadas cutaneomucosas idiopáticas que pueden asociarse a melanoniquia longitudinal. A pesar de ser considerado una enfermedad benigna sin manifestaciones sistémicas ni potencial maligno, es clave realizar el diagnóstico diferencial con otros trastornos pigmentarios, en especial con el síndrome de Peutz-Jeghers. Se presenta aquí el caso de un paciente con este síndrome poco frecuente. (AU)
Laugier-Hunziker syndrome is a rare acquired pigmentary disorder that is characterized by idiopathic mucocutaneous pigmentation that may be associated with longitudinal melanonychia. Although this syndrome is considered a benign disease with no systemic manifestations or malignant potential, it is important to rule out other mucocutaneous pigmentary disorders, especially Peutz-Jeghers syndrome. We report the case of a patient with this unusual syndrome. (AU)
Subject(s)
Humans , Male , Aged , Hyperpigmentation/diagnosis , Lip Diseases/diagnosis , Skin Diseases/diagnosis , Skin Diseases/pathology , Peutz-Jeghers Syndrome/diagnosis , Hyperpigmentation/pathology , Diagnosis, Differential , Lip Diseases/pathology , Mouth Diseases/diagnosis , Mouth Diseases/pathologyABSTRACT
El melanoma es considerado una neoplasia melanocítica maligna; la localización subungueal corresponde al 0.7-3.5% de todos los melanomas. Clínicamente se presenta como una melanoniquia en general asintomática. Comunicamos un paciente masculino de 67 años, que consulta por presentar melanoniquia estriada en el cuarto dedo de la mano izquierda. El estudio histopatológico de biopsia informa un melanoma acral, por lo que se procede a realizar resección completa de la lesión con amputación de la falange distal; el paciente evolucionó satisfactoriamente. Este melanoma se origina de la matriz ungular, aunque se ha propuesto la asociación con traumas, su etiología no está clara. Histológicamente, se caracteriza por una proliferación de melanocitos atípicos o fusiformes, con grados variables de invasión; algunas lesiones son pigmentadas y otras amelanóticas. Se debe establecer el diagnóstico diferencial con: hematomas, osteomielitis, onicomicosis, granuloma piógeno, paroniquia, enfermedad de Kaposi, carcinoma espinocelular, entre otras. Algunos factores pronósticos incluyen profundidad de invasión, índice mitótico, ulceración, índice de proliferación con Ki 67 para nombrar solo algunos factores del denominado “histopronóstico”. El retraso en el diagnóstico del melanoma subungueal condiciona un mal pronóstico. El tratamiento apunta hacia la intervención quirúrgica en estadios tempranos, con evaluación del ganglio centinela (esto varía según la escuela académica). Sin embargo, actualmente se hace referencia a nuevos fármacos, que modifican la respuesta inmune o que intervienen en el metabolismo celular, con lo que se dan los primeros pasos para modificar la historia natural de esta enfermedad.
Introduction: melanoma is considered a biologically aggressive neoplasm. It’s more common in the 6th decade. Subungual melanoma corresponding to 0.7-3.5% of all melanomas. The most common locations are hallux, thumb, index and ring. Clinically, it presents as an asymptomatic melanonychia. Case Report: male aged 67 who consulted for striated melanonychia fourth finger left hand. Biopsy histopathological study reports malignant melanoma. Complete resection of the lesion was performed with amputation of distal phalanx. Patient evolves satisfactorily. Discussion: this melanoma originates from the nail matrix. Although it has been proposed partnership with traumas, its etiology is unclear. Hasn’t been able to establish an association with race, skin type and sun exposure, as in other melanoma’s types. Histologically it is characterized by a proliferation of atypical melanocytes or fusiform with varying degrees of invasion. Some injuries are pigmented and others may be amelanotic. Should be established the differential diagnosis with hematomas, osteomyelitis, onychomycosis, pyogenic granuloma, paronychia, among other injuries. Some prognostic factors include depth of invasion, mitotic rat, ulceration, proliferation index among others. The delay in diagnosis of subungual melanoma determines a poor prognosis. The treatment aims to surgery in early stages, with evaluation of sentinel node. But now referred to new drugs that modify the immune response or that involve its cellular metabolism thus taking the first steps to modify the natural history of this disease.
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No abstract available.
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BACKGROUND: Longitudinal melanonychia is characterized by pigmented bands on the nail plate. It is not unusual to encounter pediatric melanonychia patients in the dermatologic clinic. OBJECTIVE: To assess the clinical manifestations of melanonychia in childhood in Korea, we reviewed the pediatric patient registry of a tertiary referral hospital in Korea. METHODS: Patients under fifteen years of age with longitudinal melanonychia referred between January, 2001, and March, 2015, were enrolled in the study. All patients had clinical as well as photo records. Clinical characteristics including age, sex, location, disease duration, width and color of pigmentation, morphological change over time, underlying disease, and dermoscopic images or biopsy findings were evaluated where available. RESULTS: A total of 92 patients had 158 pigmented nails, with more than one melanonychia identified in 14 patients. The patient sample included 43 male and 49 female patients with an average age of 6.1 years at diagnosis. A follow-up examination was performed for 132 nails in 80 patients with a mean period of 27.8 months and morphological changes were identified in 61 nails. Changes included remission or aggravation of pigmentation. In 48% and 17% of patients, nail plate dystrophy and Hutchinson's sign were observed, respectively. Dermoscopic image analysis was available for 79 nails. A nail biopsy was performed for 8 nails and none showed evidence of malignant melanoma. CONCLUSION: Pediatric longitudinal melanonychia generally presents a benign nature despite overt morphological changes, diffuse pigmentation, or Hutchinson's sign. Characteristically, melanonychia in childhood is frequently accompanied by nail dystrophy. Based on clinical reference of our study, aggressive nail biopsy may not be routinely necessary in pediatric melanonychia.
Subject(s)
Female , Humans , Male , Biopsy , Diagnosis , Follow-Up Studies , Korea , Melanoma , Pigmentation , Tertiary Care CentersABSTRACT
The new targeted anticancer drugs as well as the older traditional chemotherapy agents are associated with adverse effects on skin, hair, nails and mucosa. These toxic effects can cause great distress to the patient leading to decreased quality of life and interruption in treatment. Aims: To study the mucocutaneous adverse effects of both single and combined chemotherapy regimens in cancer patients. Materials and Methods: We studied 53 cancer patients attending the oncology outpatient department or those admitted in the oncology ward of Father Muller Medical College Hospital, Mangalore between October 2012 and September 2013. The adverse effects of chemotherapy on skin, hair, nails and mucosa were noted. Results: The most common adverse effects observed in the study were nail changes in 33 (62.2%) patients, followed by hair changes in 20 (37.7%) patients, skin changes in 19 (33.9%) patients, and mucosal changes in 2 (3.7%) patients. The skin changes were acneiform rash in 5 (27.7%) patients, xerosis in 4 (22.2%) patients, hyperpigmentation in 4 (22.2%) patients, and toxic epidermal necrolysis, hand foot syndrome, extravasation, erythema nodosum, and supravenous hyperpigmentation in 1 patient each. The most common nail fi nding was melanonychia seen in 26 (78.7%) patients. Hair changes were in the form of anagen effl uvium seen in 20 (37.7%) patients. Mucosal changes seen were pigmentation of tongue and stomatitis in one case each. Limitations: Sample size is small. Conclusions: While these side effects are generally not life-threatening, they can be a source of signifi cant morbidity. Knowledge about the adverse effects of anti-cancer drugs will help in accurate diagnosis and management, thereby improving the quality of life.
Subject(s)
Acne Vulgaris/chemically induced , Antineoplastic Agents/adverse effects , Exanthema/chemically induced , Female , Humans , Male , Nail Diseases/chemically induced , Skin Diseases, Vesiculobullous/chemically induced , Skin Manifestations/chemically inducedABSTRACT
Melanonychia is a darkening of the nails and its importance is that it may indicate the presence of a subungual malignant melanoma. Because the incidence of malignant melanoma is quite small in children, clinicians have had difficulties as to whether or not to perform a nail matrix biopsy in the children with melanonychia. Herein, we report the case of a 6-year-old boy that presented with melanonychia, which was determined to be confirmed melanoma in situ.
Subject(s)
Child , Humans , Biopsy , Incidence , Melanoma , NailsABSTRACT
Objective To estimate the value of clinical parameters (such as patients' age,longitudinal melanonychia width and location) for the differential diagnosis of malignant and benign longitudinal melanonychia as well as for the evaluation of the necessity for invasive management.Methods A retrospective study was performed on 28 cases of subungual malignant melanoma collected from 2000 to 2010 as well as on 62 cases of benign longitudinal melanonychia from 2005 to 2010.Clinical analysis was carried out to compare the differences in clinical parameters such as.patients' age,longitudinal melanonychia width and lesional location,between the malignant melanoma and benign longitudinal melanonychia cases.Logistic regression analysis and ROC method were used to determine valuable clinical parameters for the differential diagnosis of malignant and benign longitudinal melanonychia.Results Significant differences were observed in the median age at diagnosis (23.0 years vs.52.5 years,Z =5.44,P ＜ 0.01 ),age at onset (21.0 years vs.48.0 years,Z =4.70,P ＜ 0.01 ),and longitudinal melanonychia width (3.0 mm vs.15.0 mm,Z =5.69,P ＜ 0.01 ) between the patients with malignant melanoma and benign longitudinal melanonychia.The involvement of thumb and hallux was observed in 77.8％ of the subungual melanoma cases,and 48.3％ of the benign cases (x2 =6.57,P ＜ 0.05).ROC method and Logistic regression analysis indicated that the age at onset and diagnosis as well as width of longitudinal melanonychia were of diagnostic value for the differential diagnosis of malignant and benign longitudinal melanonychia.Conclusions Not all longitudinal melanonychia cases need an invasive management at the time of awareness.The age at onset and diagnosis,width of melanonychia and site of the onset appear to be valuable in the differential diagnosis of malignant and benign longitudinal melanonychia,and there is a possibility to guide clinical diagnosis and treatment by establishing a mathematical model with these parameters.
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Melanonychia is characterized by a tan, brown or black pigmentation within the nail plate. It results from increased melanin deposition. The stimulators and causes of melanonychia are numerous, but fungal melanonychia is rare. Candida species rarely cause black pigmentation of infected nails and only a few cases have been reported in the literature. We report a case of melanonychia in the left big toenail because of Candida parapsilosis in a 47-year-old woman without any pathologic history.
Subject(s)
Female , Humans , Middle Aged , Candida , Melanins , Nails , Onychomycosis , Pigmentation , Triacetoneamine-N-OxylABSTRACT
Laugier-Hunziker syndrome is a rare idiopathic acquired hyperpigmentation of oral mucosa and lips which is often associated with longitudinal melanonychia. This condition is known to be an entirely benign disease with no systemic manifestations. Herein we report a case of a 54-year-old woman presenting with a 7-year history of asymptomatic oral pigmentation and linear pigmented streaks of several fingernails. Histological examination taken from the mucosal lesion of tongue revealed increased pigmentation at the epithelial basal layer and a few melanophages in the submucosa. The lack of a family history coupled with the absence of any polyps on the endoscopic examinations of upper and lower bowel as well as the clinical features with late onset were all in favor of a diagnosis of Laugier-Hunziker syndrome. The significance of this disease is due to the need to differentiate this disorder from other pigmentary disorders of the oral mucosa, especially Peutz-Jeghers syndrome.
Subject(s)
Female , Humans , Middle Aged , Hyperpigmentation , Lip , Mouth Mucosa , Nails , Peutz-Jeghers Syndrome , Pigmentation , Polyps , TongueABSTRACT
Laugier-Hunziker syndrome (LHS) is a rare acquired benign macular hyperpigmentation of the lips and oral mucosa which is often associated with longitudinal melanonychia. LHS is known to be an entirely benign condition with no systemic manifestations, which requires patient reassurance as the only intervention. The significance of this condition is due to its inclusion in differential diagnoses of pigmentary disorders of the oral mucosa, especially Peutz-Jeghers syndrome. We report a case of Laugier-Hunziker syndrome in a 66-year-old woman who presented with longitudinal pigmented bands on her fingernails and multiple, pigmented macules on the lip and tongue.
Subject(s)
Aged , Female , Humans , Diagnosis, Differential , Hyperpigmentation , Lip , Mouth Mucosa , Nails , Peutz-Jeghers Syndrome , TongueABSTRACT
Progressive cribriform and zosteriform hyperpigmentation (PCZH) was first described in 1978 by Rower and his colleagues as having the following clinical characteristics: a single area of uniformly-tan, cribriform, macular pigmentation in a zosteriform distribution, an histologically mild increase of melanin pigment in the basal cell layer and complete absence of nevus cells, no preceding history of skin rash, injury or inflammation, onset after birth with gradual extension - age at onset was in the second decade of life, lack of other associated cutaneous or internal abnormalities. We hereby report an atypical case of PCZH in a 16-year-old boy, who presented with multiple, cribriform and zosteriform hyperpigmented lines on his right arm and leg. This is the first ever reported case which has an association with Becker's nevus and melanonychia.
Subject(s)
Adolescent , Humans , Male , Arm , Exanthema , Hyperpigmentation , Inflammation , Leg , Melanins , Nevus , Parturition , PigmentationABSTRACT
BACKGROUND: Melanonychia is a darkening of the nail caused by deposition of melanin or other substances such as exogenous materials, microorganisms, drugs, PUVA, benign elanocytic hyperplasia or nevus, and malignant melanoma. OBJECTIVE: The purpose of this study was to describe the clinicopathologic features of melanonychia. METHODS: We reviewed the medical records, clinical photographs, and histopathologic slides of 25 cases of melanonychia from April 1995 to April 2006 in our department. RESULTS: The most common clinical pattern of pigmentation was longitudinal melanonychia (13 cases), followed by diffuse (9 cases), and focal melanonychia (3 cases). The final histopathologic diagnoses were fungal infection (4 cases), hemorrhage (2 cases), benign melanocytic hyperplasia (5 cases), melanocytic hyperplasia with nuclear atypia (4 cases), melanoma (5 cases), and no specific findings (5 cases). Of 13 cases of longitudinal melanonychia, 4 cases were benign melanocytic hyperplasia, 3 were melanocytic hyperplasia with nuclear atypia and 3 were malignant melanoma. In diffuse melanonychia, 3 were fungal melanonychia and 2 were melanoma. Three cases of focal melanonychia were associated with fungal infection, hemorrhage or no specific findings respectively. CONCLUSION: This study demonstrated variable clinicopathologic features of melanonychia. For the good management of melanonychia, dermatologists should be aware of the various clinical and histopathological features of this condition and recommend nail biopsy for early detection of melanoma when it is necessary.
Subject(s)
Biopsy , Diagnosis , Hemorrhage , Hyperplasia , Medical Records , Melanins , Melanoma , Nevus , PigmentationABSTRACT
A number of conditions can cause melanonychia striata, but its main importance is that it may indicate the presence of a subungual melanoma. A biopsy of the nail matrix can be performed to rule out melanoma, but nail matrix boipsies sometimes result in a permanent nail deformity. Since the incidence of melanoma in children is quite small, there is some controversy as to whether this procedure should routinely be performed in the pediatric age group. We report a 7-year-old boy with melanonychia striata resulting from a congenital melanocytic nevus.