Melanonychia striata L60.8

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 18.12.2020

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Synonym(s)

longitudinal melanonychia; Nail pigmentation striped; Striped nail pigmentation

Definition
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Stripy brown/black discoloration (pigmentation) of different origin, rarely occurring in Caucasians, running longitudinally across the nail plate.

Occurrence/Epidemiology
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Frequently as melanocytic pigmentation in dark ethnic groups (96% of those over 50!).

Etiopathogenesis
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Melanocytes are present in the nail root. These are inactive in Caucasians under physiological conditions. They become active by certain exogenous or endogenous factors and thus melanin-forming. This then leads to nail pigmentation of varying widths and streaks.

Melanocytic, microbiological, tumorous or endogenous factors have been described as triggers:

Localization
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Both the physiological form in coloured people and the exogenous form occurs from the 1st to the 5th finger in decreasing frequency.

Differential diagnosis
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Therapy
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If a malignant melanoma is suspected, a bioptic examination is necessary with appropriate surgical measures. S.u. melanoma, subunguales.

Progression/forecast
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In case of melanocytic nail pigmentation, an exact and reliable clinical control of the findings (with photo documentation) is necessary.

In most cases it is a harmless anomaly, which can be regressed even after years of existence (see illustration with control photos).

A subungual malignant melanoma which cannot be excluded - in adults a malignancy rate between 5 and 10% is assumed (Cooper 2015) - shows progressive growth, recognizable by the widening of the pigment strip of a deepening of the coloration and signs of onychodystophy (due to the invasive displacement of the tumor into the nail matrix).

Melanoma development in children is an absolute rarity.

However, the diagnosis "malignancy" is only possible through a biopsy (growth disturbance of the nail matrix).

Note(s)
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Diagnostics: Clinic, reflected light microscopy, biopsy (from nail root or nail bed). Diagnostic confirmation (type of pigment) via histological or microbiological evidence of the cause.

Literature
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  1. Andre J et al (2003) Longitudinal melanonychia. J Am Acad Dermatol 49: 776
  2. Cooper C et al.(2015) A clinical, histopathologic, and outcome study of melanonychia striata
    inchildhood. J Am Acad Dermatol 72:773-779
  3. Haneke E (1991) Laugier-Hunziker-Baran syndrome. Dermatologist 42: 512-515
  4. Kreusch J et al (1992) Incident light microscopic evaluation of pigmented nail lesions. Dt Dermatol 7: 1006-1015
  5. Neynaber S et al (2004) Longitudinal melanonychia associated with hydroxyarbamide ingestion. JDDG 2: 588-591
  6. Parodi P et al (2003) Desmoplastic melanoma of the nail. Ann Plast Surg 50: 658-662
  7. Prat C et al (2008) Longitudinal melanonychia as the first sign of Addison's disease. J Am Acad Dermatol 58:522-524.

  8. Van Laborde S et al (2000) Developments in the treatment of nail psoriasis, melanonychia striata, and onychomycosis. A review of the literature. Dermatol Clin 18: 37-46

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Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

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Last updated on: 18.12.2020