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Dermoscopy of the Nail Plate, Nail Matrix, and Nail Bed

  • Nilton Di Chiacchio
  • Diego L. Bet
  • Nilton Gioia Di Chiacchio
Chapter

Abstract

  • Dermoscopy of the nail unit allows better characterization of pigmented lesions compared with the naked eye.

  • Dermoscopy easily differentiates subungual hemorrhages from melanin inclusions, and may reveal clues regarding the diagnosis of fungal melanonychia.

  • Background and lines are evaluated on dermoscopy of the nail plate, according to the color and regularity of the pattern.

  • Gray usually indicates melanocytic activation, whereas brown indicates melanocytic hyperplasia. Sometimes it may be hard to differentiate gray from light brown.

  • An irregular brown/black pattern may indicate a melanoma of the nail unit. Intraoperative polarized dermoscopy of the nail matrix and nail bed allows direct visualization and better characterization of pigmented lesions originating longitudinal melanonychia.

  • Four main patterns are described and validated for dermoscopy of the nail matrix and bed:
    1. 1.

      Gray regular pattern: indicates melanocytic activation

       
    2. 2.

      Regular brown lines: indicate benign melanocytic hyperplasia

       
    3. 3.

      Regular lines with regular globules and blotches: indicate lentigo and melanocytic nevis

       
    4. 4.

      Irregular pattern: favors a melanoma of the nail matrix

       
  • These dermoscopic patterns demonstrate good histopathological correlation and enhance diagnosis accuracy, even for non–nail experts.

  • Intraoperative dermoscopy permits better characterization of surgical margins for biopsy and excision, aiding the surgical management of longitudinal melanonychias.

Keywords

Irregular Pattern Nail Plate Pigment Lesion Blue Nevus Regular Line 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  • Nilton Di Chiacchio
    • 1
  • Diego L. Bet
    • 1
  • Nilton Gioia Di Chiacchio
    • 2
  1. 1.Hospital do Servidor Público MunicipalSão PauloBrazil
  2. 2.Medical School of ABCSão PauloBrazil

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