ABSTRACT
BACKGROUND AND AIMS: Melanonychia can be a manifestation of benign or malignant pathology and often poses a diagnostic challenge on clinical examination. Even with distinguishing dermoscopic features (nail plate), it can be quite difficult to determine the nature of pigmentation as complete assessment of nail bed and matrix is still not possible. Intraoperative dermoscopy (IOD) can serve as a useful tool to appreciate the bed and matrix changes. The aim here is to study the intraoperative dermoscopic features in patients with melanonychia and correlate with histopathology. METHODS: 20 consecutive patients with melanonychia were recruited. Inclusion criteria was melanonychia of sudden onset, progressive nature, irregular width/color/symmetry on dermoscopy, positive Hutchinson sign, solitary nail involvement or associated nail dystrophy. Preoperative dermoscopy was performed and recorded. Patients were planned for nail matrix biopsy, during which IOD was performed over nail matrix and bed after removal of the nail plate. Images were recorded and analyzed and correlated with the histopathology. RESULTS: Out of 20 patients, 12 were females and 8 males. On IOD-histopathological correlation, 2 patients were found to have melanoma of the nail unit, 5had nail lichen planus, 9 had benign melanocytic nevi, and 4 had fungal melanonychia. IOD revealed fine, parallel and regular lines of pigmentation localized to proximal nail bed and matrix in all patients with benign melanonychia, while dark thick bands with irregular borders, dots, globules, streaks and structureless areas in the two patients with melanoma. Fungal melanonychia revealed an unremarkable nail bed and matrix on IOD. CONCLUSION: Intraoperative dermoscopycan help in determining the nature of melanonychia and obviate the need to perform biopsy in certain cases. It can also aid in delineating the most suitable site for biopsy, along with grossly assessing the extent of involvement in case of malignancy.
ABSTRACT
OBJECTIVES: Post-kala-azar dermal leishmaniasis (PKDL) is well recognized in the Indian subcontinent and is not infrequently confused with leprosy. The present report describes findings in an unusual case of PKDL. METHODS: We report an adult male who presented with firm nodules on the face and extremities, along with hypopigmented macules on the neck with deformity and hypoesthesia over the right upper extremity. The patient had experienced similar lesions seven years previously and had used multibacillary multi-drug therapy for leprosy with complete resolution of the nodules. RESULTS: At the current presentation, skin smears from ear lobes and nodules were negative on Ziehl-Neelsen staining. Histopathological examination revealed a dermal lymphohistiocytic infiltrate with plasma cells. Giemsa staining of a tissue smear revealed Leishmania donovani bodies, and an rK39 antigen test was positive. The patient responded well to oral miltefosine. CONCLUSIONS: This case is noteworthy because the patient exhibited an unusual combination of healed leprosy sequelae and active PKDL lesions, which caused a diagnostic dilemma.
