Original articleA clinical, histopathologic, and outcome study of melanonychia striata in childhood
Section snippets
Methods
After obtaining approval from the Northwestern University Lurie Cancer Center and the Northwestern University Internal Review Board we identified 30 cases of melanonychia striata in pediatric patients from our clinical database at Northwestern Medicine. Study inclusion required patients to be aged 18 years or younger with a clinical presentation of melanonychia striata and available histopathology from a nail matrix biopsy specimen. We examined the medical records to obtain demographic data,
Results
The clinical and histopathologic features are summarized in Table I. The median age was 6 years (mean 7.3 years; range 2-18 years). Fourteen patients were female and 16 were male. In 27 cases (90%) the melanonychia was located on a fingernail, with the thumb the most common site of occurrence (8 cases, 29.7%). The remaining 3 appeared on the great toe (2 cases) and on the second toe (1 case). At clinical presentation, 8 had a pigmented band equal to or greater than 3 mm, and in 5 it was equal
Discussion
Clinical features of melanonychia striata that raise concern for melanoma include pigment bands broader than 3 mm,13 changing pigmentation or shape, associated nail dystrophy, Hutchinson sign, bands that are not homogeneous in color, blurred lateral borders, irregular lines that are not parallel on dermoscopy, and rapid evolution.1 Overall, our cases shared clinical features with those described in other large case studies of melanonychia striata in children (Table III).8, 9, 14 They displayed
References (19)
- et al.
Longitudinal melanonychia in children: a clinical and histopathologic study of 40 cases
J Am Acad Dermatol
(1999) - et al.
Nail matrix nevi: a clinical and histopathologic study of twenty-two patients
J Am Acad Dermatol
(1996) - et al.
Histologic features of congenital melanocytic nevi in infants 1 year of age or younger
J Am Acad Dermatol
(1995) - et al.
Childhood subungual melanoma in situ in diffuse nail melanosis beginning as expanding longitudinal melanonychia
Pediatr Dermatol
(2005) - et al.
Histologic distinction between subungual lentigo and melanoma
Am J Surg Pathol
(2008) - et al.
Immunohistochemical study of 40 cases of longitudinal melanonychia
Am J Dermatopathol
(2011) - et al.
In situ melanoma of the nail unit in children: report of two cases in fair-skinned Caucasian children
Pediatr Dermatol
(2012) - et al.
In situ melanoma of the nail unit presenting as a rapid growing longitudinal melanonychia in a 9-year-old white boy
Dermatol Surg
(2014) - et al.
Nail melanoma in children: differential diagnosis and management
Dermatol Surg
(2008)
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2022, Journal of the American Academy of DermatologyCitation Excerpt :Most NMN acquired during adulthood are usually easy to differentiate from SUM on the basis of clinical and dermatoscopic features.1-3 However, as observed on other cutaneous sites, childhood NMN frequently combine semiologic features of irregularity and asymmetry with a multicomponent pigmentation of the nail plate and surrounding tissue that could suggest malignancy.4,5 Nail matrix biopsy, an invasive procedure associated with emotional distress and the risk of permanent nail scarring, is difficult to propose in cases with a low-level of suspicion, especially in newborns or very young children.
Clinical features and natural course of pediatric longitudinal melanonychia: A retrospective cohort study in Korea
2022, Journal of the American Academy of DermatologyLongitudinal melanonychia in childhood: a great challenge
2022, Anais Brasileiros de DermatologiaCitation Excerpt :However, such findings are common in childhood LM, without translating into an increased risk of malignancy. The MN, a major cause of LM in children, often presents with rapid growth, wide bands, heterogeneous pigmentation, irregular lines, triangular shape, and Hutchinson's sign, as demonstrated in other studies.3,4,7–10 Its recurrence after excision is frequent, as in Cases 1 and 3.
[Translated article] Subungual Melanocytic Lesions in Pediatric Patients
2022, Actas Dermo-Sifiliograficas
Supported by the Irene D. Pritzker Foundation.
Disclosures: Dr Gerami has served as a consultant to Castle Biosciences Inc, Myriad Genetics, and DermTech Inc, and has received honoraria for this. Dr Guitart has served as a consultant to Castle Biosciences Inc and has received honoraria for this. Ms Cooper, Drs Arva, Yélamos, Wagner, and Shen, Ms Lee, Ms Obregon, and Ms Sholl have no conflicts of interest to declare.