Baran R, Kechijian P
Nail Disease Center, Cannes, France.
J Am Acad Dermatol. 1996 Jan;34(1):87-90. doi: 10.1016/s0190-9622(96)90839-7.
Hutchinson's sign, periungual extension of brown-black pigmentation from longitudinal melanonychia onto the proximal and lateral nailfolds, is an important indicator of subungual melanoma. However, experience has demonstrated that Hutchinson's sign, although valuable, is not an infallible predictor of melanoma. Periungual pigmentation is present in a variety of benign disorders and, therefore, may lead to overdiagnosis of subungual melanoma. Periungual hyperpigmentation occurs in at least one nonmelanoma skin cancer, Bowen's disease of the nail unit. Hyperigmentation of the nail bed and matrix may reflect through the "transparent" nailfolds simulating Hutchinson's sign. "Pseudo-Hutchinson's sign" is a phrase coined to encompass these three simulants of Hutchinson's sign. Each represents a misleading clue to the diagnosis of subungual melanoma. Total reliance on the (apparent) presence or absence of periungual pigmentation may lead to overdiagnosis or underdiagnosis of subungual melanoma. All relevant clinical and historical information, including the presence or absence of periungual pigmentation, must be carefully evaluated in a patient suspected of having subungual melanoma. Ultimately, the diagnosis of subungual melanoma is made histologically.
哈钦森征，即从纵向黑甲延伸至近端和外侧甲襞的棕黑色色素沉着，是甲下黑色素瘤的重要指标。然而，经验表明，哈钦森征虽然有价值，但并非黑色素瘤的可靠预测指标。甲周色素沉着存在于多种良性疾病中，因此可能导致甲下黑色素瘤的过度诊断。甲周色素沉着至少会出现在一种非黑色素瘤皮肤癌，即甲单位的鲍恩病中。甲床和甲母质的色素沉着可能透过“透明”的甲襞反映出来，模拟哈钦森征。“假性哈钦森征”这一术语是为涵盖哈钦森征的这三种模拟情况而创造的。每种情况都是诊断甲下黑色素瘤的误导性线索。完全依赖甲周色素沉着的（明显）有无可能导致甲下黑色素瘤的过度诊断或漏诊。对于疑似患有甲下黑色素瘤的患者，必须仔细评估所有相关的临床和病史信息，包括甲周色素沉着的有无。最终，甲下黑色素瘤的诊断需依靠组织学检查。
