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.

Equivocal Longitudinal Melanonychia in a 3-Year-Old Caucasian Girl: Rapid Evolution and Fading during Digital Dermoscopy Follow-Up

“…In sum, equivocal dermoscopic findings in LM seem to reflect to some extent dynamic processes during the natural life cycle of NMN in children and should not per se prompt immediate biopsy, but should be interpreted in the context of patient's age, patient's history, and clinical evolution of the lesion before choosing appropriate management decisions [19]. Taking into account these data and the volatility of nevi in children, most authors agree that clinical follow-up with digital dermoscopy imaging is appropriate in most cases of childhood melanonychia and that nail unit biopsies should only be considered in the presence of high-risk clinical features, since performing nail unit biopsies in children is particularly challenging and can result in permanent nail dystrophy [11,19,20]. Implementation of fluorescence in situ hybridization tests or evaluation of nuclear and cytoplasmic expression of the cell cycle and apoptosis regulator protein p16, which is not expressed in all childhood melanomas opposed to Spitz nevi and benign melanocytic nevi, may in the future aid in the evaluation of borderline lesions [2,21].…”

Melanoma‐like features in pediatric longitudinal melanonychia: A systematic review and meta‐analysis

“…The studies were published between 1996 and 2023 and were conducted in the following countries and regions: Asia (n = 13), 6,[17][18][19][20][21][22][23][24][25][26][27][28] Europe (n = 6), [29][30][31][32][33][34] North America (n = 3), [35][36][37] and South America (n = 1). 38 One of the studies was conducted internationally and collected cases from 30 different countries.…”

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

“…In a retrospective study of 21 pediatric Korean patients with melanonychia, histological examination of their biopsies rendered 8 diagnoses of lentigo, 3 diagnoses of nail matrix nevi, and 10 of "functional" melanonychia, with no findings of melanoma [11]. Colin Tan et al [12] conducted a retrospective observational study in Singapore in which they sought to investigate the clinical decision to perform a biopsy of melanonychia striata in Asian children. Ethnicity was documented and included patients who were Chinese, Malay, Indian, and "other," but skin phototype was not reported.…”