Melanonychia Follow-up

  • Author: Anokhi Jambusaria-Pahlajani, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Mar 19, 2010
 

Further Outpatient Care

Patients with longitudinal melanonychia of a single digit who decline a biopsy should receive close follow-up with their dermatologist, and monitoring of the melanonychia should be part of a routine monthly self-skin examination. Additionally, the physician may use a dermatoscope to monitor melanonychia.

If changes suggestive of melanoma are observed, a biopsy should be performed.

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Complications

Postoperative nail dystrophy is a common complication and should be taken into consideration before a nail biopsy is performed.[4] Postoperative nail dystrophy is less likely to occur with biopsies of the distal matrix than biopsies of the proximal matrix.

Complete excision when longitudinal melanonychia is located in the lateral third of the nail unit with a lateral longitudinal excision is a sampling method that may result in less cosmetic deformity than other methods.

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Prognosis

In cases of melanonychia associated with systemic diseases, treatment of the primary condition may improve the nail pigmentation. Similarly, discontinuation of any offending drugs may improve melanonychia.

The prognosis of patients with subungual melanoma is poor. In a 2007 series of 106 subungual melanomas, 48 (45%) patients developed a recurrence or metastasis and, of these, 33 (69%) died from their disease during the follow-up period (median 56 mo). Patients with a melanoma deeper than 2.5 mm had a statistically worse survival rate than those with thin melanomas.[31]

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Patient Education

Patients should be instructed to follow lesions of suspected benign causes of longitudinal melanonychia for any change in color, pattern, size of the band, or new onset pain and/or ulceration, as these can be signs of subungual melanoma.

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Contributor Information and Disclosures
Author

Anokhi Jambusaria-Pahlajani, MD  Resident Physician, Department of Dermatology, University of Pennsylvania School of Medicine

Anokhi Jambusaria-Pahlajani, MD is a member of the following medical societies: American Association of Physicians of Indian Origin and Phi Beta Kappa

Disclosure: Nothing to disclose.

Coauthor(s)

Adam I Rubin, MD  Assistant Professor of Dermatology, University of Pennsylvania School of Medicine

Adam I Rubin, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, American Society of Dermatopathology, International Society of Dermatology, International Society of Dermatopathology, Medical Dermatology Society, and Women's Dermatologic Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Richard K Scher, MD  Professor of Dermatology, University of North Carolina

Richard K Scher, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Cryosurgery, American College of Physicians, American Dermatological Association, American Geriatrics Society, American Medical Association, Association of Military Surgeons of the US, International Society for Dermatologic Surgery, New York Academy of Sciences, Noah Worcester Dermatological Society, Rhode Island Medical Society, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Jeffrey Meffert, MD  Assistant Clinical Professor of Dermatology, University of Texas Health Science Center-San Antonio

Jeffrey Meffert, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Association of Military Dermatologists, and Texas Dermatological Society

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Department of Dermatology, Geisinger Medical Center

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

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Longitudinal melanonychia secondary to a nevus.
Pigmented longitudinal streak secondary to a nail matrix melanoma.
 
 
 
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