Nail discoloration in pediatric skin of color patients

Bellet, Jane S.

doi:10.1111/pde.14659

Cited by 3 publications

(7 citation statements)

References 38 publications

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“…From a practical perspective, nail biopsy in young children usually requires sedation, and the risk of nail scarring is theoretically increased due to the small size of the nail matrix. Due to the painful nature of the procedure and the fact that most cases render a benign diagnosis, many authors recommend conservative monitoring (e.g., 6-month follow-up) [1,9,14,16,[18][19][20][21]. Unfortunately, half of our patients did not return for the follow-up appointment, and therefore, a conservative approach cannot always be considered safe in the general population due to difficulties in the continuity of health care.…”

Section: Discussionmentioning

confidence: 94%

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Monodactylous Longitudinal Melanonychia in Pediatric Skin of Color: A Case Series and Review

Andrade¹,

Mashoudy²,

Morrison³

et al. 2023

Skin Appendage Disord

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Introduction: Longitudinal melanonychia, a pigmented longitudinal streak on the nail, is a common clinical finding that may be associated with subungual melanoma with varying presentation depending on race and skin tone. It has been long reported that darker skinned ethnicities have a higher prevalence of longitudinal melanonychia in the US population (e.g., African Americans with 77% prevalence) [Indian J Dermatol. 2021;66(4):445], but unfortunately, there are limited studies exclusively looking at longitudinal melanonychia in pediatric patients of color. Case Presentation: In this case series, we review the current literature and report the findings of 8 cases of longitudinal melanonychia in children with skin types IV or greater. Out of the 8 cases identified, only 4 returned to the clinic for monitoring (n = 4), and there was an average of 20.8 months between the initial and final visits. Of the patients that returned for follow-up, 2 showed no relevant changes in the nail pigmentation, 1 showed fading of the band, and 1 patient showed enlargement of the band to involve the whole nail. Conclusion: Although many sources recommend a conservative approach to treatment that involves monitoring and follow-up, our findings indicate that a wait-and-see method cannot be applied to all cases in the pediatric population due to disruptions in continuity of care. An individualized approach considering such factors should be employed for each patient, and certain high-risk features of the ABCDEF nail melanoma model may be relevant in pediatric cases.

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Section: Discussionmentioning

confidence: 94%

“…The lesion may have either a rectangular or triangular shape, and the presence of nail dystrophy due to melanin-related nail plate disruption may be seen. Hutchinson's sign may sometimes be observed, though its presence is not pathognomonic of melanoma, especially in pediatric populations [1] (Fig. 1).…”

Section: Clinical Features and Pathogenesismentioning

confidence: 99%

Monodactylous Longitudinal Melanonychia in Pediatric Skin of Color: A Case Series and Review

Andrade¹,

Mashoudy²,

Morrison³

et al. 2023

Skin Appendage Disord

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“…When assessing for abnormalities, ask the patient if they have had rapid hyperpigmented changes or new onset hyperpigmentation, widening hyperpigmented stripe, triangular pigmented shape, and dystrophy of nails. 25 As noted above, in people who have FSP V or VI, skin injury or inflammation doesn't appear as erythema, as it does in those who have lighter skin tones. Instead, in people who have darker skin tones, injury or inflammation may occur as hyperpigmentation or slightly to significantly darker than the surrounding skin (see Figure 2).…”

Section: Skin Irritation and Erythemamentioning

confidence: 96%

“…In addition, because of the quantity of melanin and melanogenesis in people who have dark skin tone and the black-brown hue produced when injuries occur, inflammatory hyperpigmentation—not erythema (redness)—may be present 18. (For more information, see Table 1 19-25…”

Section: Head-to-toe Assessmentmentioning

confidence: 99%

Skin Assessment in Patients with Dark Skin Tone

Pusey-Reid

Quinn

Samost

et al. 2023

AJN, American Journal of Nursing

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There is a scarcity of nursing literature, studies, and educational materials on the assessment and early recognition of both common and serious integumentary and general health issues in people with dark skin tones. Nurses must be exposed to such learning resources to be adequately prepared to care for patients with diverse skin tones and to help reduce health disparities and promote health equity. This article provides faculty, nursing students, and clinicians with basic information about the assessment of dark skin tone and calls for action in academia and professional practice to ensure nurses and nursing students can effectively perform skin assessments in all patients.

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“…Diagnosis is challenging since no clear criteria have been established to differentiate between melanocytic activation, nail unit nevi, and NUM in children. While certain features (i.e., band width, pigment involving the nail folds) may guide the decision to perform a biopsy of LM to rule out NUM in adults, benign pediatric melanonychias may manifest similarly to adult NUM [ 75 , 78 , 79 ]. Pediatric nail unit nevi most often involve the thumbnail and may appear with a dark brown to black band, the band width being >3 mm, involve the entire nail plate with pigment extending to the proximal nail fold, and have irregular bands on dermoscopy [ 78 ].…”

Section: Pediatric Nummentioning

confidence: 99%

Adult and Pediatric Nail Unit Melanoma: Epidemiology, Diagnosis, and Treatment

Conway

Bellet

Rubin

et al. 2023

Cells

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Nail unit melanoma (NUM) is an uncommon form of melanoma and is often diagnosed at later stages. Approximately two-thirds of NUMs are present clinically as longitudinal melanonychia, but longitudinal melanonychia has a broad differential diagnosis. Clinical examination and dermoscopy are valuable for identifying nail findings concerning malignancy, but a biopsy with histopathology is necessary to confirm a diagnosis of NUM. Surgical treatment options for NUM include en bloc excision, digit amputation, and Mohs micrographic surgery. Newer treatments for advanced NUM include targeted and immune systemic therapies. NUM in pediatric patients is extremely rare and diagnosis is challenging since both qualitative and quantitative parameters have only been studied in adults. There is currently no consensus on management in children; for less concerning melanonychia, some physicians recommend close follow-up. However, some dermatologists argue that the “wait and see” approach can cause delayed diagnosis. This article serves to enhance the familiarity of NUM by highlighting its etiology, clinical presentations, diagnosis, and treatment options in both adults and children.

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Nail discoloration in pediatric skin of color patients

Cited by 3 publications

References 38 publications

Monodactylous Longitudinal Melanonychia in Pediatric Skin of Color: A Case Series and Review

Monodactylous Longitudinal Melanonychia in Pediatric Skin of Color: A Case Series and Review

Skin Assessment in Patients with Dark Skin Tone

Adult and Pediatric Nail Unit Melanoma: Epidemiology, Diagnosis, and Treatment

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