Pigmented lesions of the nail bed - Clinical assessment and biopsy.
BACKGROUND
Subungual melanoma is an uncommon type of melanoma that can be difficult to diagnose. Patients often present with advanced primary lesions and have an associated increased risk of nodal disease. Delays in diagnosis are believed to contribute to poor patient outcomes.


OBJECTIVE
The objective of this article is to offer an approach to assessing and managing patients who present with subungual pigmented lesions. We describe the anatomy of the nail bed to offer a rationale for our technique of nail bed biopsy, and warn of the potential to cause permanent nail dystrophy through other approaches.


CONCLUSIONS
Many clinicians have limited experience in assessing lesions of the nail apparatus.Subungual pigmentation has extremely broad differential diagnoses, which include a variety of benign pathologies. A systematic approach to assessment, and early referral of patients with suspicious lesions to a specialist unit, has the potential to improve patient outcomes.
Michael Alexander
MA
Rtshiladze
Jonathan Raymond
JR
Stretch
David Alexander
DA
Stewart
Robyn Pm
RP
Saw
D046169:Dermoscopy / Q000379:methods; D003937:Diagnosis, Differential; D006801:Humans; D008545:Melanoma / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D009260:Nail Diseases / Q000175:diagnosis* / Q000601:surgery; D009262:Nails / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery; D010859:Pigmentation Disorders / Q000175:diagnosis*