Department of Dermatology, Pusan National University School of Medicine, and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.
Br J Dermatol. 2013 Jun;168(6):1224-9. doi: 10.1111/bjd.12209.
Subungual haemorrhages are characterized by well-circumscribed dots or blotches with a red to red-black pigmentation, but some cases can be difficult to distinguish from subungual melanoma by the naked eye alone. Dermoscopy has proven to be a useful, noninvasive tool in the diagnosis of pigmented lesions in the nail; however, few dermoscopic studies of subungual haemorrhages have been reported.
To investigate characteristic dermoscopic patterns of subungual haemorrhages, and to find distinctive features that can differentiate them from nail-unit melanomas.
Patients with a confirmed diagnosis of either subungual haemorrhage or nail-unit melanoma at a tertiary university hospital were included in the study. Clinical features and dermoscopic patterns were evaluated.
Sixty-four patients with a total of 90 lesions of subungual haemorrhage were enrolled in the study. The majority of cases (84%) showed combinations of more than one colour, while 16% had only one colour. The most common colour of the subungual haemorrhages was purple-black, in 37% of cases. A homogeneous pattern was observed in 92% of cases, globular patterns in 42% and streaks in 39%. Peripheral fading and periungual haemorrhages were found in 54% and 22% of cases, respectively. Destruction or dystrophy of the nail plate was observed in 16% of cases. In the 16 cases of nail-unit melanomas, Hutchinson sign, longitudinal irregular bands or lines, triangular shape of bands, vascular pattern, and ulcerations were found in 100%, 81%, 25%, 6% and 81% of cases, respectively. In contrast, these features were not found in subungual haemorrhages.
Dermoscopy provides valuable information for the diagnosis of subungual haemorrhage and aids in the differential diagnosis from nail-unit melanoma.
甲下出血的特征是边界清晰的点或斑，呈红色至红黑色色素沉着，但有些病例仅凭肉眼可能难以与甲下黑素瘤区分。皮肤镜检查已被证明是诊断甲下色素病变的一种有用的、非侵入性工具；然而，关于甲下出血的皮肤镜检查研究较少。
研究甲下出血的特征性皮肤镜模式，并寻找能将其与甲单元黑素瘤区分开来的特征。
本研究纳入了在一所三级大学医院确诊为甲下出血或甲单元黑素瘤的患者。评估了临床特征和皮肤镜模式。
研究共纳入了 64 例患者，共 90 处甲下出血病变。大多数病例（84%）表现为一种以上颜色的组合，而 16%的病例只有一种颜色。甲下出血最常见的颜色是紫黑色，占 37%。92%的病例表现为均匀模式，42%的病例表现为球形模式，39%的病例表现为条纹状模式。54%的病例出现周边褪色，22%的病例出现甲周出血。16%的病例观察到甲板破坏或营养不良。在 16 例甲单元黑素瘤中，100%、81%、25%、6%和 81%的病例分别发现了 Hutchinson 征、纵向不规则带或线、带的三角形形状、血管模式和溃疡。相比之下，这些特征并未在甲下出血中发现。
皮肤镜检查为甲下出血的诊断提供了有价值的信息，并有助于与甲单元黑素瘤进行鉴别诊断。
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