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Dermoscopic Examination of Nail Pigmentation
Sandra Ronger, MD, PhD;
Sandrine Touzet, MD;
Claire Ligeron, MD;
Brigitte Balme, MD;
Anne Marie Viallard, MD;
Danièle Barrut, MD;
Cyrille Colin, MD, PhD;
Luc Thomas, MD, PhD
Arch Dermatol. 2002;138:1327-1333.
Background Diagnosis of longitudinal melanonychia is usually difficult, and neither
a single clinical criterion nor a combination of symptoms currently can be
used to clearly distinguish malignant from benign bandlike pigmented nail
lesions. Biopsy is painful and often leaves definitive dystrophic scars.
Objectives To describe and evaluate dermoscopic patterns associated with longitudinal
nail pigmentation.
Patients and Methods A total of 148 unselected consecutive cases of longitudinal melanonychia
were included over a period of 4 years (20 melanoma, 37 nevi, 16 drug-induced
nail pigmentation, 45 nail apparatus lentigo of various types, 8 ethnic-type
nail pigmentation, and 22 subungual hemorrhages). All patients were recruited
from the dermatology unit outpatient clinic of the Hôtel Dieu de Lyon.
All cases were photographed in vivo under oil immersion (dermoscopy). Patterns
were recorded prior to final pathologic diagnosis. An independent biostatistics
unit performed statistical evaluation using 7 semiologic patterns.
Results Melanoma cases were significantly associated with a brown coloration
of the background and the presence of irregular longitudinal lines (P = .001). Blood spots were mostly observed in subungual hemorrhages
(P = .001); however, their presence could not rule out melanoma.
Micro–Hutchinson sign was observed only in melanoma, but its rare occurrence
did not allow any statistical evaluation of its specificity. Nail apparatus
nevi were significantly associated with a brown coloration of the background
and the presence of regular lines (P = .001). Nail apparatus
lentigo, ethnic-type pigmentation, and drug-induced pigmentation were significantly
associated with homogeneous longitudinal thin gray lines and gray coloration
of the background (P = .001). Microscopic longitudinal grooves
were unspecific, occurred in several conditions, and were associated with
any type of ungual discoloration.
Conclusions We believe that dermoscopic examination of the nail plate in cases of
longitudinal melanonychia provides useful information that could help clinicians
to more accurately decide if a nail apparatus biopsy should be performed;
however, histopathologic diagnosis remains the gold standard in doubtful cases.
From the Dermatology Unit, Hôtel Dieu de Lyon (Drs Ronger, Ligeron,
Balme, Viallard, Barrut, and Thomas), INSERM U346 (Drs Ronger and Thomas),
and the Technology Assessment Unit, Department of Medical Information, Hôpitaux
de Lyon (Drs Touzet and Colin), Lyon, France.
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