title: Detection of early lesions of "ungual" malignant melanoma.
abstract: BACKGROUND
  The nail area is commonly affected by malignant melanoma. The prognosis of malignant melanoma of the nail is poor, because at the time of diagnosis most lesions are in the advanced stage. Correct diagnosis of early lesions could improve the prognosis.
  
  
  METHODS
  For 3 years, all patients with nail pigmentation at the dermatology clinic were screened for five specific criteria for the diagnosis of early lesions of malignant melanoma. Histologic examination was performed on 10 of 29 lesions.
  
  
  RESULTS
  Five of the 29 lesions were advanced malignant melanoma, easily diagnosed clinically. Two of the remaining 24 lesions fulfilled most of our clinical criteria of early malignant melanoma of the nail apparatus; that is, they appeared as melanonychia striata during adulthood, were wide in breadth measuring 9 and 11 mm, and showed variegated shades of brown. Periungual pigmented macule (Hutchinson's sign) was observed in one of the two cases. Total resection of the lesions was performed, followed by skin grafting.
  
  
  CONCLUSIONS
  Histologically, an increased number of atypical melanocytes, mainly arranged as solitary units, were observed only in the epithelia of the nail matrix and of the nail-bed, confirming that these lesions were "ungual" malignant melanoma in situ. Such an early lesion of malignant melanoma of the nail apparatus can be completely cured with conservative excision, and the phalanx of the affected digit can be preserved.
authors.affiliation: Department of Dermatology, Shinshu University School of Medicine, Nagano, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Ishihara
authors.forename: K
authors.initials: K
authors.lastname: Matsumoto
authors.forename: S
authors.initials: S
authors.lastname: Kawachi
authors.forename: T
authors.initials: T
authors.lastname: Saida
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D009260:Nail Diseases / Q000473:pathology* / Q000601:surgery; D013997:Time Factors