ABSTRACT
Melanoma of the nail apparatus is challenging to diagnose for both dermatologists and dermatopathologists. Misdiagnosis or delayed diagnosis of nail unit melanoma can have fatal consequences and legal ramifications. This review educates dermatopathologists on challenges and traps they should be aware of to avoid misdiagnosis of nail unit melanoma. We present illustrative difficult cases that introduce several themes regarding challenges in the diagnosis of nail unit melanoma: specimens with subtle histopathologic findings, challenges in immunoperoxidase interpretation, and how clinical knowledge and surgical procedural knowledge are mandatory to make the diagnosis. Dermatopathologists will be aware of when and how to suspect nail unit melanoma in unusual circumstances.
Subject(s)
Melanoma , Nail Diseases , Skin Neoplasms , Humans , Skin Neoplasms/diagnosis , Skin Neoplasms/pathology , Nail Diseases/diagnosis , Nail Diseases/pathology , Melanoma/diagnosis , Melanoma/pathology , Nails/pathology , Diagnostic Errors , SyndromeSubject(s)
Carcinoma , Plasmacytoma , Skin Neoplasms , Humans , Plasmacytoma/diagnosis , Plasmacytoma/pathology , Skin/pathology , Skin Neoplasms/pathologyABSTRACT
A 26-year-old male presented with a 2-year history of a hyperkeratotic growth from the left index finger. Histopathology was consistent with an acquired digital fibrokeratoma with changes of a pleomorphic fibroma. Lesional cells were negative for CD34, Rb, and p53, and were positive for FXIIIa. We introduce the pleomorphic acquired digital fibrokeratoma as a novel clinicopathologic entity.
