ABSTRACT
Background: Onychomycosis is one of the most common nail disorders. Mycological examination by potassium hydroxide (KOH) mount and fungal culture is the most commonly used diagnostic method. However, it is associated with a low sensitivity. Aims: To evaluate the technique of subungual hyperkeratosis nail biopsy in diagnosing onychomycosis in HIV-infected and immunocompetent adults and compare it with mycological examination. Methods: 34 HIV-positive patients who presented clinically with onychomycosis were recruited in the study from the beginning. There was no screening done for patients with onychomycosis. This has been clarified in manuscript under the heading of methods. Results: All the fungal cultures yielded dermatophytes correlating with the biopsy findings. Only hyphal form of fungus was detected in KOH examination, indicating it was not a contaminant. Clinical types of onychomycosis are stated in discussion. Conclusions: PAS stain of subungual hyperkeratosis nail biopsy was the most sensitive in the diagnosis of onychomycosis in both HIV-infected and non-infected groups.
ABSTRACT
Nail biopsy (NB) is an investigation that is not routinely resorted to by most of the dermatologists. The commonly cited reasons are the complexity of the procedure, risk of scarring and the reluctance of the patient. However, in cases with isolated nail psoriasis, isolated nail lichen planus, onychomycosis not confirmed on direct microscopy and culture, or longitudinal melanonychia, the treating dermatologist is left with no choice but to resort to this procedure. Nail as a unit, is capable of projecting only a limited number of clinical manifestations. This is responsible for the more or less similar clinical presentation of many different nail disorders. Hence, a practical knowledge of the indications, appropriate patient selection, procedural details and histopathological interpretation of a NB is a must-have for any practicing dermatologist. The risk of scarring is none to minimal if appropriate type of biopsy is performed, not to mention the wealth of histopathological data that can be retrieved from the nail unit. This article aims to explore the various practical do's and don'ts for the NB and tells us what to expect from of the procedure.
ABSTRACT
Subungual squamous cell carcinoma often presents with atypical clinical manifestations, which can lead to delays in diagnosis. The presence of a tumor can be masked by the presence of infections or other misleading pathological conditions. The authors report on techniques for adequate biopsy and excision of such tumors. A case of subungual squamous cell carcinoma with invasion into the underlying bone is presented. Clinical histopathological evidence is reviewed along with human papillomavirus typing. Accurate diagnosis requires a high index of suspicion and appropriate tissue sampling.
Subject(s)
Humans , Biopsy , Carcinoma, Squamous Cell , MasksABSTRACT
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.