Midline/paramedian longitudinal matrix excision with flap reconstruction: Alternative surgical techniques for evaluation of longitudinal melanonychia

Collins, Siobhan C.; Cordova, Katharine B.; Jellinek, Nathaniel J.

doi:10.1016/j.jaad.2009.08.003

Cited by 21 publications

(9 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The excision extends from the most proximal aspect of the nail matrix to the digit pulp 49,50 . When the lesion involves the mid‐portion of the nail plate, a longitudinal matrix and bed excision with flap reconstruction can be used 51 …”

Section: Diagnosismentioning

confidence: 99%

Diagnosis and treatment of nail melanoma: a review of the clinicopathologic, dermoscopic, and genetic characteristics

Darmawan

Ohn

Mun

et al. 2022

Acad Dermatol Venereol

View full text Add to dashboard Cite

Nail melanoma (NM) is an important differential diagnosis in patients with longitudinal melanonychia. However, diagnosis is often challenging as it is difficult to differentiate from other pigmented nail disorders. The main challenge for diagnosis is obtaining adequate nail matrix biopsy specimens for histopathological assessment. Furthermore, the histopathological changes in the early stages of NM are subtle and contribute to a delay in diagnosis and care. Therefore, the integration of clinical and histopathological analyses is essential. Clinical and dermoscopic features, such as a broadened width of asymmetric bands in an irregular pattern, with multicolour pigmentation, periungual pigmentation, and continuous growth, are features that support the diagnosis of NM. The essential histological features that must be assessed are cellular morphology, architectural features, melanocyte density, and inflammatory changes. The reported mutations in NMs were BRAF (0–43%), NRAS (0–31%), KIT (0–50%), NF1 (0–50%), and GNAQ (0–25%). Surgery is the primary treatment for NM. The recommended treatment for in situ or minimally invasive NM is functional surgery, but cases with suspected bone invasion should be treated with amputation. Targeted therapy and immunotherapy are indicated for advanced stages of NM. This review summarizes the updated guidelines for the diagnosis and treatment of NM.

show abstract

Section: Diagnosismentioning

confidence: 99%

Diagnosis and treatment of nail melanoma: a review of the clinicopathologic, dermoscopic, and genetic characteristics

Darmawan

Ohn

Mun

et al. 2022

Acad Dermatol Venereol

View full text Add to dashboard Cite

show abstract

“…Defects wider than 3 mm, however, are usually too tight to close primarily. There are several sliding matrix flaps that elegantly address such defects (FIG. ).…”

Section: Nail Matrix Flapsmentioning

confidence: 99%

“…A). The procedure is performed by incising just lateral to the matrix in the lateral nail sulcus, then undermining with the scalpel blade above the dorsal phalanx from the defect to this incision until the blade tip is visible (FIG. ).…”

Section: Nail Matrix Flapsmentioning

confidence: 99%

“…This is the least commonly used of the three flaps limited to the matrix, and reserved for defects that will invariably heal with a split nail unless adequately repaired. For such defects, the flap is cut along the proximal matrix margins, as it transitions to the eponychium at the cul‐de‐sac (FIG. ).…”

Section: Nail Matrix Flapsmentioning

confidence: 99%

“…Soft tissue rearrangement (“flap”), a standby of cutaneous surgery, has been documented sparingly in the nail surgery literature . This manuscript will review the major indications and techniques for utilization of soft tissue rearrangement of the nail apparatus.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Flaps in nail surgery

Jellinek

2012

Dermatol Ther

Self Cite

View full text Add to dashboard Cite

Nail surgery, particularly when it involves the matrix, may lead to permanent nail deformity, with associated disruption in digital function. Soft tissue rearrangement of the nail tissues, nail flaps, can be used to reconstruct the nail to preserve a more normal nail plate. Other nail flaps can also be used to correct congenital malalignment, to cover full thickness nail unit defects, and for nail fold reconstruction. The indications and techniques for successful flap reconstruction are reviewed.

show abstract

Multiple Onychopapillomas and BAP1 Tumor Predisposition Syndrome

Lebensohn,

Ghafoor,

Bloomquist

et al. 2024

JAMA Dermatol

View full text Add to dashboard Cite

ImportanceBRCA1-associated protein (BAP1) tumor predisposition syndrome (TPDS) is a cancer genodermatosis associated with high risk of uveal and cutaneous melanoma, basal cell carcinoma, and multiple internal malignant neoplasms, including mesothelioma and renal cell carcinoma. Early detection of the syndrome is important for cancer surveillance and genetic counseling of family members who are at risk.ObjectiveTo determine the prevalence of nail abnormalities in individuals with pathogenic germline variants in BAP1.Design, Setting, and ParticipantsIn this prospective cohort study, individuals who were known carriers of pathogenic BAP1 germline variants were consecutively enrolled between October 10, 2023, and March 15, 2024. Dermatologic evaluation for nail abnormalities was performed, including a history of nail abnormalities and associated symptoms, physical examination, medical photography, and nail biopsy for histopathology. This was a single-center study conducted at the National Institutes of Health Clinical Center.Main Outcomes and MeasuresPrimary outcomes were the prevalence and spectrum of nail changes and histopathologic characterization.ResultsAmong 47 participants (30 female [63.8%]; mean [SD] age, 46.4 [15.1] years) ranging in age from 13 to 72 years from 35 families, nail abnormalities were detected in 41 patients (87.2%) and included leukonychia, splinter hemorrhage, onychoschizia, and distal nail hyperkeratosis. Clinical findings consistent with onychopapilloma were detected in 39 patients (83.0%), including 35 of 40 individuals aged 30 years or older (87.5%). Nail bed biopsy was performed in 5 patients and was consistent with onychopapilloma. Polydactylous involvement with onychopapillomas was detected in nearly all patients who had nail involvement (38 of 39 patients [97.4%]).Conclusions and RelevanceThis study found that BAP1 TPDS was associated with a high rate of nail abnormalities consistent with onychopapillomas in adult carriers of the disease. Findings suggest that this novel cutaneous sign may facilitate detection of the syndrome in family members who are at risk and patients with cancers associated with BAP1 given that multiple onychopapillomas are uncommon in the general population and may be a distinct clue to the presence of a pathogenic germline variant in the BAP1 gene.

show abstract

Midline/paramedian longitudinal matrix excision with flap reconstruction: Alternative surgical techniques for evaluation of longitudinal melanonychia

Cited by 21 publications

References 25 publications

Diagnosis and treatment of nail melanoma: a review of the clinicopathologic, dermoscopic, and genetic characteristics

Diagnosis and treatment of nail melanoma: a review of the clinicopathologic, dermoscopic, and genetic characteristics

Flaps in nail surgery

Multiple Onychopapillomas and BAP1 Tumor Predisposition Syndrome

Contact Info

Product

Resources

About