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Related Experiment Video

Updated: Jan 7, 2026

Non-Invasive Visualization of Nailbed Microvascular Morphology in Mice Using Capillaroscopy
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Non-Invasive Visualization of Nailbed Microvascular Morphology in Mice Using Capillaroscopy

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Intraoperative Nail Matrix Assessment in Longitudinal Melanonychia.

Eran Galili1,2, Ofir Kotek1,2, Avner Shemer1,2

  • 1Department of Dermatology, Sheba Medical Center, Ramat-Gan, Israel.

International Journal of Dermatology
|January 2, 2026
PubMed
Summary

Intraoperative nail matrix examination (IONME) is a simple, equipment-free tool that accurately distinguishes subungual melanoma (SUM) from benign longitudinal melanonychia (LM). This method aids diagnosis and patient follow-up.

Keywords:
intraoperative nail matrix examinationlongitudinal melanonychiasubungual melanoma

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Area of Science:

  • Dermatology
  • Oncology
  • Surgical Pathology

Background:

  • Longitudinal melanonychia (LM) diagnosis is challenging, with subungual melanoma (SUM) mimicking benign conditions.
  • Intraoperative dermoscopy (IOD) aids diagnosis but requires specialized equipment.
  • Intraoperative nail matrix examination (IONME) offers a simpler, equipment-free alternative for direct visual inspection.

Purpose of the Study:

  • To evaluate the diagnostic performance of IONME compared to histopathology and nail plate dermoscopy for differentiating SUM in situ from benign LM.
  • To assess the utility of IONME in improving clinicopathologic correlation and guiding patient management.

Main Methods:

  • Retrospective analysis of 110 LM cases, including 16 SUM in situ and 94 benign cases.
  • Classification of IONME patterns into three morphological categories: barely visible, regular, and irregular.
  • Correlation of IONME patterns with histopathology, calculating diagnostic accuracy, sensitivity, and specificity.

Main Results:

  • An irregular IONME pattern showed high sensitivity (0.88) and specificity (0.78) for detecting SUM in situ.
  • IONME outperformed nail plate dermoscopy in diagnostic accuracy (sensitivity 0.81, specificity 0.55).
  • Excellent intra-observer agreement was achieved for IONME pattern classification (κ = 0.84-0.88).

Conclusions:

  • IONME is a valuable, equipment-free intraoperative tool for distinguishing SUM in situ from benign LM.
  • IONME enhances clinicopathologic correlation and supports patient follow-up decisions.
  • The technique can be readily integrated into routine LM biopsy documentation.