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Patterns of nail matrix and bed of longitudinal melanonychia by intraoperative dermatoscopy
Sergio Henrique Hirata1, Sergio Yamada1, Mauro Yoshiaki Enokihara1
1Department of Dermatology, Universidade Federal de São Paulo, São Paulo, Brazil.
Background:
The dermatoscopic examination of the nail plate has been recently introduced for the evaluation of pigmented nail lesions. There is, however, no evidence that this technique improves diagnostic accuracy of in situ melanoma.
Objective:
To establish and validate patterns for intraoperative dermatoscopy of the nail matrix.
Methods:
Intraoperative nail matrix dermatoscopy was performed in 100 consecutive bands of longitudinal melanonychia that were excised and submitted to histopathologic examination.
Results:
We identified 4 dermatoscopic patterns: regular gray pattern (hypermelanosis), regular brown pattern (benign melanocytic hyperplasia), regular brown pattern with globules or blotch (melanocytic nevi), and irregular pattern (melanoma).
Limitations:
Nail matrix dermatoscopy is an invasive procedure that can not routinely be performed in all cases of melanonychia.
Conclusion:
The patterns described present high sensitivity and specificity for intraoperative differential diagnosis of pigmented nail lesions.
Insights
Intraoperative nail matrix dermatoscopy helps differentiate benign from malignant pigmented nail lesions. This study identified four distinct dermatoscopic patterns, improving diagnostic accuracy for melanoma.
Area of Science:
- Dermatology
- Oncology
- Histopathology
Background:
- Dermatoscopic examination of the nail plate is a new technique for evaluating pigmented nail lesions.
- Evidence is lacking on whether this technique improves diagnostic accuracy for in situ melanoma.
Purpose of the Study:
- To establish and validate patterns for intraoperative dermatoscopy of the nail matrix.
- To improve the diagnostic accuracy of pigmented nail lesions.
Main Methods:
- Intraoperative nail matrix dermatoscopy was performed on 100 consecutive bands of longitudinal melanonychia.
- Excised lesions were submitted for histopathologic examination.
Main Results:
- Four dermatoscopic patterns were identified: regular gray (hypermelanosis), regular brown (benign melanocytic hyperplasia), regular brown with globules/blotch (melanocytic nevi), and irregular (melanoma).
- These patterns demonstrated high sensitivity and specificity.
Conclusions:
- Nail matrix dermatoscopy is invasive and not suitable for all melanonychia cases.
- The identified patterns aid in the intraoperative differential diagnosis of pigmented nail lesions.
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