Should we biopsy melanonychia striata in Asian children? A retrospective observational study.

Abstract:

BACKGROUND AND OBJECTIVES:Melanonychia striata is common in children of darker-skinned Asian races, while subungual melanoma is extremely rare and it is difficult to make a diagnosis clinically. However, performing nail unit biopsies in children is particularly challenging and can result in permanent nail dystrophy. The aim of this study was to review the clinical and histologic characteristics of melanonychia striata in pediatric patients of Asian descent to aid in the clinical decision regarding nail biopsy. METHODS:Sixty-two pediatric patients presenting with melanonychia striata involving single or multiple nails at two tertiary pediatric dermatology clinics in Singapore between 2005 and 2015 were reviewed. Clinical and histopathological data were analyzed, including age at onset, age at presentation, location, color, width, presence of Hutchinson's sign, pseudo-Hutchinson's sign, nail dystrophy, length of follow-up, and clinical evolution. Histopathological assessment was performed by three senior dermatopathologists independently for cases that underwent a nail biopsy. RESULTS:No cases of subungual melanoma were detected in our series. Solitary melanonychia of the thumbnail with a single uniform color was the most common presentation. Pseudo-Hutchinson's sign was commonly observed. Consensus in histological diagnosis emerged amongst all three dermatopathologists in only half of the cases biopsied. CONCLUSION:The occurrence of melanoma in Asian children presenting with melanonychia is extremely rare. We recommend clinical follow-up and anticipatory guidance for these patients and nail unit biopsy only in the presence of high-risk clinical features.

journal_name

Pediatr Dermatol

journal_title

Pediatric dermatology

authors

Colin Tan W,Wang DY,Seghers AC,Koh MJA,Nicholas Goh SG,Joyce Lee SS

doi

10.1111/pde.13934

subject

Has Abstract

pub_date

2019-11-01 00:00:00

pages

864-868

issue

6

eissn

0736-8046

issn

1525-1470

journal_volume

36

pub_type

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