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

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


  • 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.


Irregular Pattern Nail Plate Pigment Lesion Blue Nevus Regular Line 
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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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