Kaur Ishmeet, Chowdhry Sundeep, D'Souza Paschal, Jakhar Deepak, Yadav Mukesh Kumar, Kaur Onkar
Department of Dermatology and Venereology and Leprosy, ESI-PGIMSR Hospital, Basaidarapur, Delhi, India.
Department of Dermatology and Venereology and Leprosy, NDMC and Hindu Rao Hospital, Delhi, India.
Indian Dermatol Online J. 2020 Mar 9;11(2):171-176. doi: 10.4103/idoj.IDOJ_94_19. eCollection 2020 Mar-Apr.
Melanonychia can be a manifestation of benign or malignant pathology and often poses a diagnostic challenge on clinical examination. Even with distinguishing dermoscopic features (nail plate), it can be quite difficult to determine the nature of pigmentation as complete assessment of nail bed and matrix is still not possible. Intraoperative dermoscopy (IOD) can serve as a useful tool to appreciate the bed and matrix changes. The aim here is to study the intraoperative dermoscopic features in patients with melanonychia and correlate with histopathology.
20 consecutive patients with melanonychia were recruited. Inclusion criteria was melanonychia of sudden onset, progressive nature, irregular width/color/symmetry on dermoscopy, positive Hutchinson sign, solitary nail involvement or associated nail dystrophy. Preoperative dermoscopy was performed and recorded. Patients were planned for nail matrix biopsy, during which IOD was performed over nail matrix and bed after removal of the nail plate. Images were recorded and analyzed and correlated with the histopathology.
Out of 20 patients, 12 were females and 8 males. On IOD-histopathological correlation, 2 patients were found to have melanoma of the nail unit, 5had nail lichen planus, 9 had benign melanocytic nevi, and 4 had fungal melanonychia. IOD revealed fine, parallel and regular lines of pigmentation localized to proximal nail bed and matrix in all patients with benign melanonychia, while dark thick bands with irregular borders, dots, globules, streaks and structureless areas in the two patients with melanoma. Fungal melanonychia revealed an unremarkable nail bed and matrix on IOD.
Intraoperative dermoscopycan help in determining the nature of melanonychia and obviate the need to perform biopsy in certain cases. It can also aid in delineating the most suitable site for biopsy, along with grossly assessing the extent of involvement in case of malignancy.
甲黑线可为良性或恶性病变的表现，在临床检查中常构成诊断挑战。即使具有特征性的皮肤镜表现（甲板），由于仍无法对甲床和甲母质进行全面评估，确定色素沉着的性质也可能相当困难。术中皮肤镜检查（IOD）可作为一种有用的工具来观察甲床和甲母质的变化。本研究旨在探讨甲黑线患者的术中皮肤镜特征，并与组织病理学结果进行相关性分析。
连续纳入20例甲黑线患者。纳入标准为甲黑线突然出现、呈进行性、皮肤镜下宽度/颜色/对称性不规则、Hutchinson征阳性、单个指甲受累或伴有甲营养不良。术前进行皮肤镜检查并记录。患者计划行甲母质活检，在拔除甲板后，对甲母质和甲床进行术中皮肤镜检查。记录并分析图像，并与组织病理学结果进行相关性分析。
20例患者中，女性12例，男性8例。通过IOD与组织病理学结果的相关性分析，发现2例患者为甲单位黑色素瘤，5例为甲扁平苔藓，9例为良性黑素细胞痣，4例为真菌性甲黑线。IOD显示，所有良性甲黑线患者的色素沉着表现为位于近端甲床和甲母质的细小、平行且规则的线条，而2例黑色素瘤患者则表现为边界不规则的深色粗带、点状、球状、条纹状和无结构区域。真菌性甲黑线在IOD下显示甲床和甲母质无明显异常。
术中皮肤镜检查有助于确定甲黑线的性质，在某些情况下可避免进行活检。它还可以帮助确定最合适的活检部位，并在恶性病变时大致评估受累范围。
