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Dermoscopic Evaluation of Longitudinal Melanonychia in Children: A Prospective Study
Mahshid Sadat Ansari1, Hamidreza Mahmoudi1, Ali Sadeghinia1
1Department of Dermatopathology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Insights
Dermoscopy of longitudinal melanonychia (LM) in children shows features mimicking melanoma, but no melanomas were found. Dermatologists must consider all dermoscopic signs and patient history before biopsy.
Area of Science:
- Dermatology
- Oncology
- Pediatrics
Background:
- Longitudinal melanonychia (LM) is a concerning sign in all age groups.
- Nail apparatus melanoma (NAM) is rare in children, but dermoscopy of benign lesions can resemble melanoma.
- Dermoscopic evaluation of pediatric LM is crucial for biopsy decisions.
Purpose of the Study:
- To review dermoscopic signs of LM in children.
- To compare dermoscopic findings in pediatric and adult LM.
- To aid in differentiating benign pediatric LM from melanoma.
Main Methods:
- Prospective study of 108 LM cases (35 children, 73 adults).
- Dermoscopic examination of all LM lesions.
- Comparison of dermoscopic features between pediatric and adult groups, including benign and malignant cases.
Main Results:
- Pediatric LM showed more black background, black band color, band color diversity, and pseudo-Hutchinson's sign than adult benign cases.
- Some pediatric LM dermoscopic features mimicked melanoma (e.g., broad band width, asymmetry, Hutchinson's sign).
- No melanomas were identified in the pediatric cohort via biopsy or follow-up; a "zigzag" pattern was noted in four children.
Conclusions:
- Dermoscopic features in pediatric LM can resemble melanoma, necessitating careful evaluation.
- Biopsy decisions for pediatric LM should integrate all dermoscopic findings, changes over time, and patient history.
- While concerning features exist, melanoma is very rare in pediatric LM.
Background:
Longitudinal melanonychia (LM) is a worrisome sign in both children and adults. Nail apparatus melanoma (NAM) can be related to LM, but it is very rare in children. Dermoscopic signs of benign lesions in children can be similar to melanoma; therefore, it is important to review dermoscopy of LM in children to make the best decision in performing biopsy.
Aims:
Biopsy taking is very challenging in LM in children. Most lesions are benign in children. The aim of this study was to review dermoscopic signs of LM in children and compare them with adults.
Materials And Methods:
In this prospective study a total of 108 LM (35 children and 73 adults) were undergone dermoscopy of LM. Dermoscopic features were compared in children and adults; both for benign lesions proven by biopsy or follow up and melanomas diagnosed histopathologically.
Results:
Black background, black band color, band color diversity and pseudo-Hutchinson's sign were more frequent in children in comparison with benign adult melanonychia. Some children's dermoscopic features of LM such as broad band width, Band color diversity, Hutchinson's sign, gray band color, asymmetry of pattern, and regression were similar to melanoma, but we did not find any melanoma by biopsy and/or follow up among children. We also detected the newly described "zigzag" pattern in four children.
Conclusion:
Dermatologists should consider all dermoscopic features of a lesion, dermoscopic sign changes in follow-up, medical, and familial history of the patient in deciding to perform biopsy of LM in children.
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