Nilton Di Chiacchio

Patterns of nail matrix and bed of longitudinal melanonychia by intraoperative dermatoscopy

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.

Nail Melanoma in Children : Differential Diagnosis and Management

The clinical presentations of melanonychia depend on the number of the bands, color, edges, and width. Whatever is the trigger factor that has activated, or increased in number, the nail matrix melanocytes, the possibility of melanoma (malignant melanocytic hyperplasia) should always be ruled out. Hutchinson’s sign (extension of the pigmentation to the proximal or lateral nail folds) is an important indicator of nail melanoma and can help the clinician in performing the diagnosis even if it is not always present. In children nail melanoma is very rare, and melanonychia is generally due to nail matrix nevi (benign melanocytic hyperplasia). To our knowledge, until now only eight cases have been reported in the literature. We report two additional cases and discuss the histopathology, differential diagnosis, and management.

Consensus on melanonychia nail plate dermoscopy

This statement, focused on melanonychia and nail plate dermoscopy, is intended to guide medical professionals working with melanonychia and to assist choosing appropriate management for melanonychia patients. The International Study Group on Melanonychia was founded in 2007 and currently has 30 members, including nail experts and dermatopathologists with special expertise in nails. The need for common definitions of nail plate dermoscopy was addressed during the Second Meeting of this Group held in February 2008. Prior to this meeting and to date (2010) there have been no evidence-based guidelines on the use of dermoscopy in the management of nail pigmentation.

Dermatologists' Accuracy in Early Diagnosis of Melanoma of the Nail Matrix

OBJECTIVE To measure and compare the accuracy of 4 different clinical methods in the diagnosis of melanoma in situ of the nail matrix among dermatologists with different levels of clinical experience. DESIGN Twelve cases of melanonychias (5 melanomas and 7 nonmelanomas) were presented following 4 successive steps: (1) clinical evaluation, (2) evaluation according to the ABCDEF rule, (3) dermoscopy of the nail plate, and (4) intraoperative dermoscopy. At each step, the dermatologists were asked to decide if the lesion was a melanoma. SETTING The test was administered at 2 dermatological meetings in 2008. PARTICIPANTS A total of 152 dermatologists, including 11 nail experts, 53 senior dermatologists, and 88 junior dermatologists. MAIN OUTCOME MEASURES The answers were evaluated as percentage of right answers for each diagnostic step according to the different grade of expertise. Differences among the percentage of right answers in the different steps were evaluated with the z test at a 5% level of significance. The agreement was investigated using Cohen kappa statistic. RESULTS The only method that statistically influenced the correct diagnosis for each category (experts, seniors, and juniors) was intraoperative dermoscopy (z test; P < .05). Cohen kappa statistic showed a moderate interobserver agreement. CONCLUSIONS Overall accuracy of dermatologists in the diagnosis of nail matrix melanoma in situ is low because the percentages of physicians who indicated the correct diagnosis during each of the first 3 clinical steps of the test ranged from 46% to 55%. The level of expertise did not statistically influence the correct diagnosis.

Nail Matrix Phenolization for Treatment of Ingrowing Nail: Technique Report and Recurrence Rate of 267 Surgeries

The great toe was disinfected with alcohol 701. Distal block anesthesia was performed, infiltrating 2 mL of lidocaine 2% without epinephrine, and a tourniquet was applied. All of the granulation tissue was removed using a curette. The lateral nail plate was detached from the lateral and proximal nail fold using a nail elevator. The nail plate was cut down its long axis from its free edge to the nail matrix and then removed using a mosquito forceps using rotational movement. Nail matrix, nail bed, and lateral nail fold were gently curetted. A dry cotton swab was used to keep a bloodless field. The nail matrix and nail bed were rubbed strongly for 2 minutes with a cotton swab soaked in phenol solution 88%. The wound was cleaned with alcohol and dried with sterile gauze. The tourniquet was removed, and the wound was dressed using an antibiotic ointment (Figure 1).

Onychomatricoma: a tumor unknown to dermatologists

A sixty-one year old white female was referred to the Dermatology Department to treat an ingrown nail in the inner corner of the left hallux. Examination of the entire nail unit showed the presence of xanthonychia in the outer corner besides thickening and increase in the transverse curvature of the nail plate. Dermoscopy and nuclear magnetic resonance of the free edge of the nail plate detected characteristic signs of onychomatricoma, a diagnosis that was later confirmed by anatomopathological exam.

Aspectos dermatoscópicos na psoríase ungueal

The authors report on their experience with the use of dermoscopy in nail psoriasis and describe their findings with this diagnostic tool.

Best Way to Treat an Ingrown Toenail

Nail phenolization is considered a useful procedure for treating ingrowing toenails. Nail phenolization is indicated when partial and definitive removal of the nail plate is necessary. Nail phenolization is simple and inexpensive, and associated with little postoperative discomfort, a quick return to normal activities, and a low rate of complication and recurrence. The Howard-Dubois and super U techniques are indicated when ingrowing nails are caused by hypertrophy of nail folds, according to the degree of severity.

Synchronous subungual glomus tumors in the same finger

The glomus tumor is an uncommon benign neoplasm of glomus cells. In the majority of the cases it is presented as a solitary painful papule in the subungual region. We report a rare case of a patient with two individual synchronous glomus tumors under the nail bed of the same finger.

Tumor glômico subungueal: estudo epidemiológico e retrospectivo, no período de 1991 a 2003

BACKGROUND: The subungual glomus tumor is a benign neoplasm of glomus cells, most frequently observed as a unique lesion on distal phalanx of fingers, and represents from 1 to 4.5% of hand neoplasms. OBJECTIVE: To evaluate the epidemiological and clinical aspects and diagnostic exams, such as histopathology and imaging methods. METHOD: Twenty cases of glomus tumor seen at the Dermatology Outpatient´s Clinics of Hospital das Clinicas and Hospital do Servidor Publico Municipal of Sao Paulo, from 1991 to 2003, were studied. RESULTS: The epidemiological findings of this study did not significantly differ from the bibliographic search carried out. The preference for fingers and greater prevalence in women were confirmed in the patients observed. The histological data were similar to those in the literature. CONCLUSIONS: The imaging methods were not used in a systematic manner in diagnosis of glomus tumor, but they are very helpful to confirm and circumscribe the tumor, especially high definition magnetic resonance imaging. Although rare, relapses occurred in 15% of cases; thus there is no need for a prolonged surgical follow-up.