title: Assessment of Patient Knowledge of Longitudinal Melanonychia: A Survey Study of Patients in Outpatient Clinics.
abstract: OBJECTIVE
  Subungual melanoma (SM) is a rare subtype of cutaneous melanoma but carries a worse prognosis than similarly staged cutaneous melanomas. Assessing patient knowledge of melanonychia is integral to early diagnosis of SM.
  
  
  OBJECTIVE
  The aim of this paper is to determine patient knowledge of longitudinal melanonychia (LM) and warning signs for SM, frequency of nail self-examinations, and satisfaction of patients with their physician's nail examinations.
  
  
  METHODS
  We conducted a survey-based study of 363 random patients at Weill Cornell Medicine in New York, USA, performed at 3 different clinics: a general dermatology clinic (n= 167), a nail specialty clinic (n= 44), and a primary care clinic (n= 152).
  
  
  METHODS
  Knowledge of the ABCDEF mnemonic for SM was compared to the ABCD mnemonic for cutaneous melanoma. Analyses were performed for patient behavior regarding suspicious nail changes as well as satisfaction with nail counseling and examination.
  
  
  RESULTS
  Only 5% (18/363) of the patients in our study had heard of the ABCDEF mnemonic. In contrast, 9.9% (36/363) of the patients had heard of the ABCD mnemonic for cutaneous melanoma. In total, 37/363 (10.2%) patients reported having LM, 32.4% (12/37) of the patients noted changes in color or width of the band, and 10.8% (4/37) presented with pain or bleeding of the nail, with only 45.9% (17/37) seeking medical attention. Only 11.8% (43/363) of the patients stated that their physician asked them about nail changes, and 1.4% (5/363) of the patients stated that they were counseled about the ABCDEF mnemonic. In comparison, 13.8% (50/363) of the patients were advised on the ABCD mnemonic for the cutaneous melanoma mnemonic. While 70.2% (255/363) of the patients stated that they used sunscreen or wore sun-protective clothing, only 31.4% (114/363) assessed their nails for color changes, with 54.9% (128/233) of the patients categorizing themselves as "very unsatisfied" with the evaluation of their nails by their dermatologist.
  
  
  CONCLUSIONS
  Our data shows that there is a lack of patient knowledge of LM and warning signs for SM. Further testing is needed to determine whether educating patients about LM, warning signs for SM, and nail self-examinations would improve patient outcomes.
authors.affiliation: Department of Dermatology, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Pierre
authors.initials: P
authors.lastname: Halteh
authors.affiliation: Department of Dermatology, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Scher
authors.affiliation: Division of Biostatistics and Epidemiology, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Amanda
authors.initials: A
authors.lastname: Artis
authors.affiliation: Department of Dermatology, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Shari
authors.initials: S
authors.lastname: Lipner
keywords: Melanoma; Melanonychia; Nail disorder