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Dermoscopy of subungual haemorrhage: its usefulness in differential diagnosis from nail‐unit melanoma
Author(s) -
Mun J.H.,
Kim G.W.,
Jwa S.W.,
Song M.,
Kim H.S.,
Ko H.C.,
Kim B.S.,
Kim M.B.
Publication year - 2013
Publication title -
british journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.304
H-Index - 179
eISSN - 1365-2133
pISSN - 0007-0963
DOI - 10.1111/bjd.12209
Subject(s) - nail (fastener) , medicine , dermatology , differential diagnosis , nail plate , nail disease , pathology , paronychia , materials science , metallurgy
Summary 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. Objectives 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.