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Melanonychia

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Book cover Scher and Daniel’s Nails

Abstract

The term melanonychia denotes a brown or black nail, not the pigment itself. There are many reasons for a brown nail, many different patterns of melanonychia (longitudinal, transverse, diffuse, etc.), and a number of diagnoses. Longitudinal melanonychia (LM) always derives from a focus of melanin-producing melanocytes in the matrix and is due to melanin incorporation into the growing nail. It is rare in light-skinned Caucasians and very common in dark-skinned individuals, particularly as they age. An acquired LM in a light-skinned person over 30-years is suspicious for ungual melanoma whereas most LMs in children and adolescents are due to a matrix lentigo or nevus. Most amelanotic nail melanomas derive from the nail bed, but even the extremely rare pigmented nail bed melanomas cannot produce an LM. Periungual pigmentation called Hutchinson’s sign, in association with an acquired LM is indicative of melanoma. Treatment of early subungual melanoma is by wide local excision of the entire nail organ with 6 mm around the anatomic border and 10 mm around Hutchinson’s sign. Advanced ungual melanoma still requires distal amputation. All brown and black nail pigmentations have to be considered in the differential diagnosis.

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Authors and Affiliations

  1. Department of Dermatology, Inselspital, University of Bern, Berne, Switzerland

    Eckart Haneke

  2. Dermatology Practice Dermaticum, Freiburg, Germany

    Eckart Haneke

  3. Centro de Dermatología Epidermis, Instituto CUF, Porto, Portugal

    Eckart Haneke

  4. Department of Dermatology, Academic Hospital, University of Gent, Ghent, Belgium

    Eckart Haneke

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  1. Eckart Haneke
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Editors and Affiliations

  1. University of Pennsylvania, Philadelphia, PA, USA

    Adam I. Rubin

  2. Brown University, Providence, RI, USA

    Nathaniel J. Jellinek

  3. Department of Dermatology, University of Mississippi Medical Center, Jackson, MS, USA

    C. Ralph Daniel III

  4. Department of Dermatology, Weill Cornell Medical College, New York, NY, USA

    Richard K. Scher

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Haneke, E. (2018). Melanonychia. In: Rubin, A.I., Jellinek, N.J., Daniel, C.R., Scher, R.K. (eds) Scher and Daniel’s Nails. Springer, Cham. https://doi.org/10.1007/978-3-319-65649-6_16

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