Dermoscopic examination of nail pigmentation
Dermoscopic examination of nail pigmentation
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DOI：
10.1001/archderm.138.10.1327
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发表时间：
2002-10-01
影响因子：
--
通讯作者：
Thomas, L
中科院分区：
文献类型：
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作者：
Ronger, S;Touzet, S;Thomas, L
背景资料：纵行性黑甲病的诊断通常很困难，目前既没有一个单一的临床标准，也没有一个症状的组合可以用来明确区分恶性和良性带状色素性甲病变。活检是痛苦的，往往会留下明确的营养不良疤痕。目的：描述和评估皮肤镜模式与纵向指甲色素沉着。患者和方法：在4年的时间里，共纳入了148例连续的纵向黑甲病例（20例黑色素瘤，37例痣，16例药物诱导的指甲色素沉着，45例各种类型的指甲色素沉着，8例种族型指甲色素沉着和22例甲下色素沉着）。所有患者均从Hotel Dieu de里昂的皮肤科门诊招募。所有病例均在油浸（皮肤镜）下进行活体拍照。在最终病理诊断之前记录模式。一个独立的生物统计学单位使用7种符号学模式进行了统计评估。结果：黑色素瘤病例与背景的棕色着色和不规则纵向线的存在显着相关（P = .001）。血斑主要见于甲下赘生物（P = .001）;然而，血斑的存在不能排除黑色素瘤。仅在黑色素瘤中观察到微Hutchinson征，但其罕见的发生不允许对其特异性进行任何统计学评价。甲器痣与背景的棕色着色和规则线条的存在显著相关（P = 0.001）。甲器雀斑样痣、种族型色素沉着和药物诱导的色素沉着与均匀的纵向细灰线和背景的灰色着色显著相关（P = .001）。显微镜纵向凹槽是非特异性的，发生在几种条件下，并与任何类型的指甲discoloration.Conclusions：我们认为，皮肤镜检查的情况下，纵向黑甲的甲板提供了有用的信息，可以帮助临床医生更准确地决定，如果甲器活检应该进行，但是，组织病理学诊断仍然是金标准在可疑的情况下。
Background: Diagnosis of longitudinal melanonychia is usually difficult, and neither a single clinical criterion nor a combination of symptoms currently can be used to clearly distinguish malignant from benign bandlike pigmented nail lesions. Biopsy is painful and often leaves definitive dystrophic scars.Objectives: To describe and evaluate dermoscopic patterns associated with longitudinal nail pigmentation.Patients and Methods: A total of 148 unselected consecutive cases of longitudinal melanonychia were included over a period of 4 years (20 melanoma, 37 nevi, 16 drug-induced nail pigmentation, 45 nail apparatus lentigo of various types, 8 ethnic-type nail pigmentation, and 22 subungual hemorrhages). All patients were recruited from the dermatology unit outpatient clinic of the Hotel Dieu de Lyon. All cases were photographed in vivo under oil immersion (dermoscopy). Patterns were recorded prior to final pathologic diagnosis. An independent biostatistics unit performed statistical evaluation using 7 semiologic patterns.Results: Melanoma cases were significantly associated with a brown coloration of the background and the presence of irregular longitudinal lines (P = .001). Blood spots were mostly observed in subungual hemorrhages (P = .001); however, their presence could not rule out melanoma. Micro-Hutchinson sign was observed only in melanoma, but its rare occurrence did not allow any statistical evaluation of its specificity. Nail apparatus nevi were significantly associated with a, brown coloration of the background and the presence of regular lines (P = .001). Nail apparatus lentigo, ethnic-type pigmentation, and drug-induced pigmentation were significantly associated with homogeneous longitudinal thin gray lines and gray coloration of the background (P = .001). Microscopic longitudinal grooves were unspecific, occurred in several conditions, and were associated with any type of ungual discoloration.Conclusions: We believe that dermoscopic examination of the nail plate in cases of longitudinal melanonychia provides useful information that could help clinicians to more accurately decide if a nail apparatus biopsy should be performed; however, histopathologic diagnosis remains the gold standard in doubtful cases.