Original article
A clinical, histopathologic, and outcome study of melanonychia striata in childhood

https://doi.org/10.1016/j.jaad.2015.01.010Get rights and content

Background

The current literature suggests that approximately 5% to 10% of melanonychia striata cases in adults are the result of subungual melanoma.

Objective

We sought to evaluate the clinical and histopathologic features and to determine the outcomes and causes of melanonychia striata in a cohort of children.

Methods

We assessed 30 childhood cases of melanonychia striata for features typically associated with melanoma such as Hutchinson sign, width of the pigmented band, evolution, color, and nail dystrophy. We assessed the histopathology of lesional biopsy specimens, including melanocyte counts and suprabasal movement of melanocytes. Clinical follow-up information was reviewed when available.

Results

Histopathologic diagnoses included subungual lentigo in 20 cases, subungual nevus in 5 cases, and atypical melanocytic hyperplasia in 5 cases. Although a number of cases exhibited worrisome clinical or histopathologic features, none showed evidence of aggressive behavior or warranted a diagnosis of melanoma.

Limitations

The sample size and follow-up times are limited.

Conclusions

Melanonychia striata is typically associated with benign stable melanocytic proliferations in childhood. The overwhelming majority of cases can be managed conservatively. Biopsy is required in select cases.

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)

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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.

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