Figure 121

Nail apparatus melanoma ALM-type, Clark's level II, 0.2 mm thickness in a finger nail. Dermoscopy shows a brown background with irregularly pigmented lines (long arrow). A faint pigmentation of the cuticle is only visible on epiluminescence microscopy (micro-Hutchinson's sign) (short arrow). (Figures 12.1-12.12 are reproduced with kind permission of Josep Malvehy, editor of the Atlas of Dermoscopy.)

Figure 12.2

Nail apparatus melanoma, ALM-type, Clark's level III, 0.6 mm thickness in a thumb nail. Dermoscopy shows a brown background (long black arrow) and brown longitudinal bands with irregular spacing, pigmention and thickness (short black arrows). Note that blood spots are present (white arrow). Some areas of parallel disruption of the bands are also visible.

Figure 12.2

Nail apparatus melanoma, ALM-type, Clark's level III, 0.6 mm thickness in a thumb nail. Dermoscopy shows a brown background (long black arrow) and brown longitudinal bands with irregular spacing, pigmention and thickness (short black arrows). Note that blood spots are present (white arrow). Some areas of parallel disruption of the bands are also visible.

Figure 12.3

Nail apparatus melanoma, ALM-type, Clark's level III, 0.65 mm thickness in the great toe nail. Dermoscopy shows a brown background

Figure 12.3

Nail apparatus melanoma, ALM-type, Clark's level III, 0.65 mm thickness in the great toe nail. Dermoscopy shows a brown background and longitudinal bands of irregular spacing, pigmentation and thickness (arrows).

3 Brown, longitudinal parallel lines with regular coloration, spacing and thickness and absence of parallelism disruption: this pattern is usually associated with a brown background and the lines appear superimposed on it. The colouration of the lines varies between lesions, from light brown to black, but the shade is consistent within each lesion. The spacing between bands is regular, and the thickness of the bands is also similar throughout the whole lesion (Figures 12.4-12.6).

4 Longitudinal, brown to black lines with irregular thickness, spacing or coloration and parallelism disruption: this pattern is also usually associated with a brown background, but the superimposed lines are heterogeneous with noticeable variegation

Figure 12.4

Nail apparatus melanocytic naevus in an adult's finger nail. Dermoscopy shows a brown background (between the two short arrows) and longitudinal bands with regular spacing, pigmentation and thickness (long arrows).

Figure 12.4

Nail apparatus melanocytic naevus in an adult's finger nail. Dermoscopy shows a brown background (between the two short arrows) and longitudinal bands with regular spacing, pigmentation and thickness (long arrows).

Figure 12.5

Nail apparatus melanocytic naevus in a child's finger nail. Dermoscopy shows a brown background (between the two short arrows) and longitudinal bands with regular spacing, pigmentation and thickness (long arrows). Note that the overall pigmentation is much darker than in Figure 12.4.

Figure 12.5

Nail apparatus melanocytic naevus in a child's finger nail. Dermoscopy shows a brown background (between the two short arrows) and longitudinal bands with regular spacing, pigmentation and thickness (long arrows). Note that the overall pigmentation is much darker than in Figure 12.4.

Figure 12.6

Nail apparatus melanocytic naevus in an adult's finger nail. Dermoscopy shows a brown background (between the two short arrows) and longitudinal bands with regular spacing, pigmentation and

Figure 12.6

Nail apparatus melanocytic naevus in an adult's finger nail. Dermoscopy shows a brown background (between the two short arrows) and longitudinal bands with regular spacing, pigmentation and thickness (long arrows).

in their coloration, spacing and thickness. This heterogeneity of the bands is also asymmetrically disposed in the area of the clinically visible pigmented band. In some areas the bands have a curved shape or abruptly interrupt their pigmentation, disrupting the parallelism of the bands (see Figures 12.2 and 12.3).

5 Homogeneous greyish lines with grey pigmentation of the background: a greyish background with superimposed thin grey lines characterizes this pattern (see Figures 12.7-12.10).

6 Micro-Hutchinson's sign: clinically, Hutchinson's sign is the pigmentation of the cuticle in the area corresponding to the pigmented nail band; it suggests the presence of melanoma yet its specificity is not absolute. Dermoscopically the micro-Hutchinson sign can be defined as a pigmentation of the cuticle, invisible to the naked eye and only observable with epiluminescent skin surface examination. Other authors have described prominent pigmentation of periungual tissue and found that irregular pattern of distribution of the pigment on dermoscopy was strongly indicative of melanoma (see Figure 12.1).

7 Microscopic longitudinal grooves: these grooves appear as microscopic superficial fractures of the nail plate. They are not always superimposed on the pigmented band and can be observed in several nail conditions. In our opinion these grooves are non-specific and do not indicate any diagnosis (see Figure 12.8).

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