Decker Ashley, Connolly Karen L, Lee Erica H, Busam Klaus J, Nehal Kishwer S
*Weill Cornell/New York Presbyterian, Division of Dermatology, New York, New York; †Memorial Sloan Kettering Cancer Center, Dermatology Service, New York, New York; ‡Memorial Sloan Kettering Cancer Center, Department of Pathology, New York, New York.
Dermatol Surg. 2017 Jun;43(6):798-804. doi: 10.1097/DSS.0000000000001112.
Clinical and dermatoscopic guidelines are used to differentiate between benign longitudinal melanonychia (LM) and subungual melanoma; however, the frequency of malignancy among patients undergoing a biopsy for LM is not well defined.
To describe the histologic diagnoses and malignancy among patients undergoing a biopsy for clinical LM.
Retrospective cohort study of consecutive patients who underwent a nail biopsy for LM at a single cancer center between 2000 and 2014. Clinical features, biopsy techniques, and histopathologic results were reviewed.
Forty-two patients with 43 biopsied lesions were included. Three of the 43 biopsies revealed melanoma (mean depth 2.1 mm). The mean age among patients with malignant lesions was 60 years compared with 58.1 years for benign lesions. The mean width of all biopsied lesions was 4.2 mm, with a mean of 10.7 mm for malignant and 3.4 mm for benign. The first digit was the most commonly involved nail in both malignant and benign lesions.
Most nail biopsies performed for LM revealed benign pathology; however, melanoma was diagnosed in a small subgroup. Although clinical and dermatoscopic guidelines help guide biopsies, they should not replace clinical judgment as malignant lesions can deviate from these guidelines.
临床和皮肤镜检查指南用于区分良性纵行黑甲（LM）和甲下黑色素瘤；然而，接受LM活检的患者中恶性肿瘤的发生率尚未明确界定。
描述接受临床LM活检的患者的组织学诊断和恶性情况。
对2000年至2014年期间在单一癌症中心接受LM指甲活检的连续患者进行回顾性队列研究。回顾了临床特征、活检技术和组织病理学结果。
纳入42例患者的43个活检病变。43例活检中有3例显示为黑色素瘤（平均深度2.1毫米）。恶性病变患者的平均年龄为60岁，良性病变患者为58.1岁。所有活检病变的平均宽度为4.2毫米，恶性病变平均为10.7毫米，良性病变平均为3.4毫米。拇指是恶性和良性病变中最常受累的指甲。
大多数因LM进行的指甲活检显示为良性病理；然而，在一小部分亚组中诊断出黑色素瘤。尽管临床和皮肤镜检查指南有助于指导活检，但它们不应取代临床判断，因为恶性病变可能偏离这些指南。
