title: Dermoscopy of subungual haemorrhage: its usefulness in differential diagnosis from nail-unit melanoma.
abstract: BACKGROUND
  Subungual haemorrhages are characterized by well-circumscribed dots or blotches with a red to red-black pigmentation, but some cases can be difficult to distinguish from subungual melanoma by the naked eye alone. Dermoscopy has proven to be a useful, noninvasive tool in the diagnosis of pigmented lesions in the nail; however, few dermoscopic studies of subungual haemorrhages have been reported.
  
  
  OBJECTIVE
  To investigate characteristic dermoscopic patterns of subungual haemorrhages, and to find distinctive features that can differentiate them from nail-unit melanomas.
  
  
  METHODS
  Patients with a confirmed diagnosis of either subungual haemorrhage or nail-unit melanoma at a tertiary university hospital were included in the study. Clinical features and dermoscopic patterns were evaluated.
  
  
  RESULTS
  Sixty-four patients with a total of 90 lesions of subungual haemorrhage were enrolled in the study. The majority of cases (84%) showed combinations of more than one colour, while 16% had only one colour. The most common colour of the subungual haemorrhages was purple-black, in 37% of cases. A homogeneous pattern was observed in 92% of cases, globular patterns in 42% and streaks in 39%. Peripheral fading and periungual haemorrhages were found in 54% and 22% of cases, respectively. Destruction or dystrophy of the nail plate was observed in 16% of cases. In the 16 cases of nail-unit melanomas, Hutchinson sign, longitudinal irregular bands or lines, triangular shape of bands, vascular pattern, and ulcerations were found in 100%, 81%, 25%, 6% and 81% of cases, respectively. In contrast, these features were not found in subungual haemorrhages.
  
  
  CONCLUSIONS
  Dermoscopy provides valuable information for the diagnosis of subungual haemorrhage and aids in the differential diagnosis from nail-unit melanoma.
authors.affiliation: Department of Dermatology, Pusan National University School of Medicine, and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.
authors.forename: J-H
authors.initials: JH
authors.lastname: Mun
authors.forename: G-W
authors.initials: GW
authors.lastname: Kim
authors.forename: S-W
authors.initials: SW
authors.lastname: Jwa
authors.forename: M
authors.initials: M
authors.lastname: Song
authors.forename: H-S
authors.initials: HS
authors.lastname: Kim
authors.forename: H-C
authors.initials: HC
authors.lastname: Ko
authors.forename: B-S
authors.initials: BS
authors.lastname: Kim
authors.forename: M-B
authors.initials: MB
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D046169:Dermoscopy / Q000379:methods; D003937:Diagnosis, Differential; D005260:Female; D006470:Hemorrhage / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008545:Melanoma / Q000175:diagnosis*; D008875:Middle Aged; D009260:Nail Diseases / Q000175:diagnosis*; D011237:Predictive Value of Tests; D012878:Skin Neoplasms / Q000175:diagnosis*; D055815:Young Adult