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Melanonychia Treatment & Management

  • Author: Chris Adigun, MD; Chief Editor: William D James, MD  more...
 
Updated: Apr 26, 2016
 

Medical Care

If melanonychia is secondary to systemic and/or dermatologic disease, treatment of the underlying condition is helpful.

If melanonychia is secondary to a drug, discontinuation of the offending agent may result in clearance.

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Surgical Care

For melanoma in situ, total excision of the nail apparatus or Mohs micrographic surgery is indicated.[37]

For invasive melanoma, amputation of the distal phalanx may be indicated.[38] Albeit controversial, total nail bed excision and reconstruction using a full-thickness graft may be considered. In a large case series, the 5-year survival rates for cutaneous melanoma of the hand versus subungual melanoma treated with a wide local excision was reported as 100% and 80%, respectively.[39] . This was due to a delay in diagnosing subungual lesions, which averaged 3.68 mm in depth versus 1.36 mm for hand melanomas of the cutaneous surface.

Because diagnosis is often delayed in these patients, sentinel lymph node biopsy after surgery may be warranted.[40]

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Consultations

Because longitudinal melanonychia is associated with a variety of systemic conditions, these cases may require referral to the appropriate specialist in order to manage the primary disease.

In cases of subungual melanoma with a poor prognosis, consultation with a hematologist/oncologist regarding potential chemotherapeutic options may be warranted.

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Complications

Postoperative nail dystrophy is a common complication and should be taken into consideration before a nail biopsy is performed.[5] 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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Long-Term Monitoring

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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Contributor Information and Disclosures
Author

Chris Adigun, MD Nail Expert; Senior Medical Advisor, Klara

Chris Adigun, MD is a member of the following medical societies: American Academy of Dermatology, American Society for Dermatologic Surgery, Council for Nail Disorders

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Valeant; Sandos; Cipher; Klara; Miramar<br/>Serve(d) as a speaker or a member of a speakers bureau for: Celgene; Cipher; Klara.

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, Women's Dermatologic Society

Disclosure: Nothing to disclose.

Panta Rouhani Schaffer, MD, PhD, MPH Resident Physician, Ronald O Perelman Department of Dermatology, New York University School of Medicine

Panta Rouhani Schaffer, MD, PhD, MPH is a member of the following medical societies: American Medical Association, American Public Health Association

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

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

Disclosure: Nothing to disclose.

Jeffrey Meffert, MD Associate Clinical Professor of Dermatology, University of Texas School of Medicine at San Antonio

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

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Richard K Scher, MD Adjunct Professor of Dermatology, University of North Carolina at Chapel Hill School of Medicine; Professor Emeritus of Dermatology, Columbia University College of Physicians and Surgeons

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

Disclosure: Nothing to disclose.

Acknowledgements

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.

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