ORIGINAL ARTICLE
Clinical and dermoscopic clues to differentiate pigmented
nail bands: an International Dermoscopy Society study
E. Benati,
1
S. Ribero,
2
C. Longo,
1
* S. Piana,
3
S. Puig,
4,5
C. Carrera,
6
F. Cicero,
7
H. Kittler,
7
T. Deinlein,
8
I. Zalaudek,
8
W. Stolz,
9
A. Scope,
10
G. Pellacani,
11
E. Moscarella,
1
B.M. Piraccini,
12
M. Starace,
12
G. Argenziano
13
1
Skin Cancer Unit, Arcispedale S. Maria Nuova-IRCCS, Reggio Emilia, Italy
2
Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy
3
Pathology Unit, Arcispedale S. Maria Nuova-IRCCS, Reggio Emilia, Italy
4
Melanoma Unit, Dermatology and Pathology Departments, Hospital Cl ınic Barcelona, Universitat de Barcelona, Barcelona, Spain
5
CIBER of Rare Diseases, Instituto de Salud Carlos III, Barcelona, Spain
6
Melanoma Unit, Dermatology and Pathology Departments, Hospital Cl ınic Barcelona, Universitat de Barcelona, Barcelona, Spain
7
Department of Dermatology, Division of General Dermatology, Medical University of Vienna, Vienna, Austria
8
Non-Melanoma Skin Cancer Unit, Department of Dermatology and Venerology, Medical University of Graz, Graz, Austria
9
Clinic for Dermatology, Allergology, and Environmental Medicine, Klinik Thalkirchner Straße St€ adt, Klinikum M€ unchen GmbH,
Munich, Germany
10
Department of Dermatology, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
11
Department of Dermatology, University of Modena, Reggio Emilia, Italy
12
Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
13
Dermatology Unit, Second University of Naples, Naples, Italy
*Correspondence: C. Longo. E-mail: longo.caterina@gmail.com
Abstract
Background Longitudinal melanonychia might be difficult to differentiate and the use of dermoscopy can be useful for
the preoperative evaluation and management decision.
Objectives The aim of our study was to investigate clinical and dermoscopic criteria of acquired longitudinal
melanonychia in adults to identify the best predictors of melanoma using a multivariate analysis and to explore eventual
new dermoscopic criteria for nail melanoma diagnosis.
Methods In this retrospective observational study, 82 histopathologically diagnosed, acquired nail pigmented bands
were collected and examined. All variables were included in the analysis and examined as possible predictors of nail mel-
anoma. Both univariate and multivariable analyses have been performed.
Results Among 82 cases, 25 were diagnosed as nail melanoma and 57 as benign lesions (including 32 melanocytic
nevi and 25 benign melanocytic hyperplasia). Melanoma cases were significantly associated with a width of the pig-
mented band higher than 2/3 of the nail plate, grey and black colours, irregularly pigmented lines, Hutchinson and micro-
Hutchinson signs, and nail dystrophy. Granular pigmentation, a newly defined dermoscopic criterion, was found in 40%
of melanomas and only in 3.51% of benign lesions.
Conclusions Dermoscopic examination of longitudinal melanonychia provides useful information that could help clini-
cians to improve melanoma recognition.
Received: 5 July 2016; Accepted: 19 September 2016
Conflicts of interest
None declared.
Funding sources
None declared.
Introduction
Longitudinal melanonychia is a brown to black pigmented
band that extends from the proximal nail fold to the distal
end of the nail plate. It may occur due to activation or
benign and malignant proliferation of melanocytes of the
nail matrix.
1,2
These entities may share clinical and dermoscopic features
making sometimes difficult to discriminate between benign
© 2016 European Academy of Dermatology and Venereology JEADV 2017, 31, 732–736
DOI: 10.1111/jdv.13991 JEADV