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Subungual Melanoma

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81. Intraoperative diagnosis of non pigmented nail tumors with ex vivo fluorescence confocal microscopy: about 10 cases. (PubMed)

) and one nodular melanoma (Group 4). The correlation was excellent for malignant epithelial tumours exhibiting marked cytological and architectural atypias (Bowen disease, invasive SCC and onycholemmal carcinoma). Onychomatricomas exhibited a very peculiar aspect with densely cellular papillae. The correlation was less favourable for minimally invasive well-differentiated SCCs with slight cytological atypias. The correlation was poor for our case of amelanotic invasive subungual melanoma.Ex vivo FCM

2014 British Journal of Dermatology

82. Paronychia (Overview)

: Bacterial, mycobacterial, or viral infection Metastatic cancer Subungual melanoma Squamous cell carcinoma Therefore, benign and malignant neoplasms should always be excluded when chronic paronychia does not respond to conventional treatment. Chronic paronychia most often occurs in persons whose hands are repeatedly exposed to moist environments or in those who have prolonged and repeated contact with irritants such as mild acids, mild alkalis, or other chemicals. People who are most susceptible include (...) . . Dahdah MJ, Scher RK. Nail diseases related to nail cosmetics. Dermatol Clin . 2006 Apr. 24(2):233-9, vii. . Yip KM, Lam SL, Shee BW, Shun CT, Yang RS. Subungual squamous cell carcinoma: report of 2 cases. J Formos Med Assoc . 2000 Aug. 99(8):646-9. . Daniel CR 3rd. Paronychia. Dermatol Clin . 1985 Jul. 3(3):461-4. . Jules KT, Bonar PL. Nail infections. Clin Podiatr Med Surg . 1989 Apr. 6(2):403-16. . Muñiz AE, Evans T. Chronic paronychia, osteomyelitis, and paravertebral abscess in a child

2014 eMedicine.com

83. Neurilemoma (Overview)

, Ozçakar L. Peripheral nerve involvement in a neurofibromatosis type 2 patient with plexiform neurofibroma of the cauda equina: a sonographic vignette. Arch Phys Med Rehabil . 2011 Sep. 92(9):1511-4. . Yeh I, Argenyi Z, Vemula SS, Furmanczyk PS, Bouffard D, McCalmont TH. Plexiform melanocytic schwannoma: a mimic of melanoma. J Cutan Pathol . 2012 May. 39(5):521-5. . Manganoni AM, Farisoglio C, Lonati A, Zorzi F, Tucci G, Pinton PG. Cutaneous epithelioid malignant schwannoma: review of the literature (...) , Carrillo R. Benign cutaneous neural tumors. Semin Diagn Pathol . 2013 Feb. 30(1):45-57. . Huntley JS, Davie RM, Hooper G. A subungual schwannoma. Plast Reconstr Surg . 2006 Feb. 117(2):712-3. . Ritter SE, Elston DM. Cutaneous schwannoma of the foot. Cutis . 2001 Feb. 67(2):127-9. . Sitenga JL, Aird GA, Nguyen A, Vaudreuil A, Huerter C. Clinical Features and Surgical Treatment of Schwannoma Affecting the Base of the Tongue: A Systematic Review. Int Arch Otorhinolaryngol . 2017 Oct. 21 (4):408-413

2014 eMedicine.com

84. Onychomatricoma (Overview)

Author: Annie Wester, MD, MS; Chief Editor: William D James, MD Share Email Print Feedback Close Sections Sections Onychomatricoma Overview Background An onychomatricoma is a subungual tumor of the fingers and toes, described in 1992. [ ] The terminology describing onychomatricomas has slowly been adjusted over time. In 1992, the original description termed this tumor an onychomatrixoma, based on the description of a filamentous, tufted tumor in the matrix. Subsequently, the term onychomatricoma (...) with fibrokeratoma of the nailbed. Am J Dermatopathol . 2001 Feb. 23(1):36-40. . DiMaio DJ, Cohen PR. Trichilemmal horn: case presentation and literature review. J Am Acad Dermatol . 1998 Aug. 39(2 Pt 2):368-71. . Yasuki Y. Acquired periungual fibrokeratoma--a proposal for classification of periungual fibrous lesions. J Dermatol . 1985 Aug. 12(4):349-56. . Baran R, Perrin C. Bowen's disease clinically simulating an onychomatricoma. J Am Acad Dermatol . 2002 Dec. 47(6):947-9. . Patel MR, Desai S. Subungual

2014 eMedicine.com

85. Blue Nevi (Follow-up)

, Celebi JT. B-RAF and melanocytic neoplasia. J Am Acad Dermatol . 2005 Jul. 53(1):108-14. . Van Raamsdonk CD, Bezrookove V, Green G, Bauer J, Gaugler L, O'Brien JM, et al. Frequent somatic mutations of GNAQ in uveal melanoma and blue naevi. Nature . 2009 Jan 29. 457 (7229):599-602. . Emley A, Nguyen LP, Yang S, Mahalingam M. Somatic mutations in GNAQ in amelanotic/hypomelanotic blue nevi. Hum Pathol . 2011 Jan. 42(1):136-40. . Lambert WC, Brodkin RH. Nodal and subcutaneous cellular blue nevi (...) . A pseudometastasizing pseudomelanoma. Arch Dermatol . 1984 Mar. 120(3):367-70. . Causeret AS, Skowron F, Viallard AM, Balme B, Thomas L. Subungual blue nevus. J Am Acad Dermatol . 2003 Aug. 49(2):310-2. . Di Cesare A, Sera F, Gulia A, Coletti G, Micantonio T, Fargnoli MC, et al. The spectrum of dermatoscopic patterns in blue nevi. J Am Acad Dermatol . 2011 Oct 24. . Dailey VL, Hameed O. Blue nevus of the prostate. Arch Pathol Lab Med . 2011 Jun. 135(6):799-802. . Cooper PH. Deep penetrating (plexiform spindle cell

2014 eMedicine.com

86. Nail Surgery (Diagnosis)

for several days. The differential diagnosis of subungual hematoma should include melanoma, glomus tumor, Kaposi sarcoma, basal cell carcinoma, squamous cell carcinoma (SCC), exostosis, melanonychia striata, fungal melanonychia, and keratoacanthomas, all of which must be excluded. [ ] To exclude a diagnosis of melanoma, biopsy must be performed in all pigmented lesions of unknown etiology. Lacerations Simple superficial lacerations of the nail are usually confined to the nail plate, nail bed, and LNFs (...) changes in the nail plate; and senile nail diseases (eg, onychauxis, subungual hyperkeratosis). [ , , ] In onychocryptosis, the primary direction of nail growth is lateral instead of the normal, forward orientation of nail growth in the longitudinal plane. A more pronounced transverse curvature of their toenails increases the likelihood of developing ingrown toenails. [ ] The laterally curved edge of the nail plate, or the nail spicule, penetrates the adjacent LNF, perforating the fold skin

2014 eMedicine.com

87. Cutaneous Melanoacanthoma (Diagnosis)

. . Schlappner OL, Rowden G, Philips TM, Rahim Z. Melanoacanthoma. Ultrastructural and immunological studies. J Cutan Pathol . 1978 Jun. 5(3):127-41. . Lambert MW, Lambert WC, Schwartz RA, et al. Colonization of nonmelanocytic cutaneous lesions by dendritic melanocytic cells: a simulant of acral-lentiginous (palmar-plantar-subungual-mucosal) melanoma. J Surg Oncol . 1985 Jan. 28(1):12-8. . Lambert WC, Lambert MW, Mesa ML, et al. Melanoacanthoma and related disorders. Simulants of acral-lentiginous (P-P-S-M (...) predilection. [ ] Oral melanoacanthoma is unrelated to seborrheic keratosis. Oral melanoacanthoma is most often seen as an enlarging flat or slightly raised area of hyperpigmentation on the buccal mucosa of adult black women. Strong homatropine methylbromide reactivity has been described, limiting its utility in distinguishing oral melanoacanthoma from malignant melanoma. Laugier-Hunziker syndrome, also known as idiopathic lenticular mucocutaneous hyperpigmentation, displays progressive mucosal

2014 eMedicine.com

88. Cutaneous Manifestations of HIV Disease (Diagnosis)

. Malignant melanoma appears to be more aggressive in patients with HIV. One study reported shorter disease-free and overall survival rates in patients with melanoma who had HIV disease, compared with those who did not have HIV. [ ] Children with AIDS have a higher risk of developing leiomyosarcoma, although the incidence is still low in this population. Kaposi sarcoma KS is an abnormally vascularized tumorlike lesion affecting skin, lymph nodes, and viscera. It is believed to be a proliferation (...) related to HIV-1 infection. [ ] Beau lines, telogen effluvium, and pallor of the nail beds are the general effects of the chronic illness. Elongation of the eyelashes and softening and straightening of the scalp hair may be observed in HIV disease, and proximal subungual onychomycosis is also usually a sign of HIV disease. The frequency of onychomycosis may be higher in men than in women. Generalized alopecia can occur in patients with HIV who are treated with indinavir, an antiretroviral protease

2014 eMedicine.com

89. Dermatologic Manifestations of Hematologic Disease (Diagnosis)

, purpura, ecchymoses, painful skin nodules, and subungual splinter hemorrhages. Livedo reticularis is a presenting sign in up to 40% of patients with the diagnosis of SLE. [ ] Skin changes defined as livedo reticularis are violaceous, red or blue, reticular, or mottled pattern of the skin of the arms, legs, and the trunk. They are not reversible with rewarming. [ ] Noninflammatory vascular thrombosis is the most frequent finding in skin lesions of patients with antiphospholipid syndrome. Differential

2014 eMedicine.com

90. Dermoscopy (Diagnosis)

Dermoscopy (Diagnosis) Dermoscopy: Overview, Technical Procedures and Equipment, Color 6 mm, enlarging lesion) contains the primary clinical criteria for diagnosing suspected cutaneous malignant melanoma. The early phase of malignant melanoma is difficult to identify because cutaneous malignant melanoma can share many clinical features with ..." /> Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your (...) , enlarging lesion) contains the primary clinical criteria for diagnosing suspected cutaneous . The early phase of malignant melanoma is difficult to identify because cutaneous malignant melanoma can share many clinical features with an atypical nevus. Several studies have described diagnostic accuracy rates ranging from 50-75%, indicating a need for additional diagnostic tools. The introduction of dermoscopy, also termed epiluminescence microscopy (ELM), has opened a new dimension in the examination

2014 eMedicine.com

91. Blue Nevi (Diagnosis)

somatic mutations of GNAQ in uveal melanoma and blue naevi. Nature . 2009 Jan 29. 457 (7229):599-602. . Emley A, Nguyen LP, Yang S, Mahalingam M. Somatic mutations in GNAQ in amelanotic/hypomelanotic blue nevi. Hum Pathol . 2011 Jan. 42(1):136-40. . Lambert WC, Brodkin RH. Nodal and subcutaneous cellular blue nevi. A pseudometastasizing pseudomelanoma. Arch Dermatol . 1984 Mar. 120(3):367-70. . Causeret AS, Skowron F, Viallard AM, Balme B, Thomas L. Subungual blue nevus. J Am Acad Dermatol . 2003 Aug (...) black in color. Lesions are usually solitary and found on the head and the neck, the sacral region, and the dorsal aspects of the hands and feet. The cellular blue nevus was first described as a variant of . Later, it was classified as a variant of blue nevus. Controversy still arises over the precise distinction of atypical cellular blue nevus from melanoma. [ ] The cellular blue nevus is a less common lesion but often clinically similar to the common blue nevus. These lesions tend to be large

2014 eMedicine.com

92. Black Heel (Calcaneal Petechiae) (Diagnosis)

. [ ] Although clinically insignificant, black heel is important because of its close clinical resemblance to melanoma. A similar lesion termed black palm (tache noir) has been described on the thenar eminence in weightlifters, gymnasts, golfers, tennis players, mountain climbers, and baseball players. [ ] Superficial cutaneous hemorrhages of other areas of the feet have been published in the literature. [ , ] Next: Pathophysiology Black heel (calcaneal petechiae) is caused by a repeated lateral shearing (...) . Benzidine stain for the histochemical detection of hemoglobin in splinter hemorrhage (subungual hematoma) and black heel. Am J Dermatopathol . 1995 Aug. 17(4):362-7. . Weedon D. Skin Pathology . 2nd ed. Elsevier Limited; 2002. 595. Media Gallery Linear petechiae on the heel, characteristic of black heel. of 1 Tables Contributor Information and Disclosures Author Christine Malcolm, MD, FRCPC Resident Physician in Dermatology, Department of Internal Medicine, University of Toronto Faculty of Medicine

2014 eMedicine.com

93. Verrucous Carcinoma (Diagnosis) (Full text)

. 2000 Apr. 27(2):179-83. . Desai A, Ugorji R, Khachemoune A. Acral melanoma foot lesions. Part 2: clinical presentation, diagnosis, and management. Clin Exp Dermatol . 2017 Dec 13. . Grinspan D, Abulafia J. Oral florid papillomatosis (verrucous carcinoma). Int J Dermatol . 1979 Oct. 18(8):608-22. . Depprich RA, Handschel JG, Fritzemeier CU, Engers R, Kubler NR. Hybrid verrucous carcinoma of the oral cavity: A challenge for the clinician and the pathologist. Oral Oncology EXTRA . 2006. 42:85-90. Deng (...) , Maloney ME. Verrucous carcinoma of the scalp. J Am Acad Dermatol . 2007 Mar. 56(3):506-7. . Sheen MC, Sheen YS, Sheu HM, Wong TW, Lee YY, Wu CF, et al. Subungual verrucous carcinoma of the thumb treated by intra-arterial infusion with methotrexate. Dermatol Surg . 2005 Jul. 31(7 Pt 1):787-9. . Bernadas SR, Evgenios E, Dimitriadis PA, Hamal P, Uppal R. Verrucous carcinoma of the upper arm. ANZ J Surg . 2014 Dec. 84(12):983-4. . Warner CL, Cockerell CJ. The new seventh edition American Joint Committee

2014 eMedicine.com PubMed

94. Melanonychia (Diagnosis)

Adigun, MD, FAAD; Chief Editor: William D James, MD Share Email Print Feedback Close Sections Sections Melanonychia Overview Background Melanonychia is brown or black pigmentation of the nail unit. Melanonychia commonly presents as pigmented band arranged lengthwise along the nail unit, and this presentation is known as longitudinal melanonychia or melanonychia striata. The most concerning cause of melanonychia is subungual melanoma, although a variety of other causes includes physiologic (...) are wider than 3 mm in greater than 50% of cases. Below are the causes of melanonychia. [ , , , ] Melanocytic activation/hyperplasia–related causes are as follows: Nevi Melanotic macule of the nail unit Melanocytic activation Subungual melanoma Physiologic causes of melanonychia are as follows: Racial melanonychia (African American, Hispanic, Indian, Japanese, other dark-skinned races) (multiple bands) Pregnancy (multiple bands) Local and regional causes of melanonychia are as follows: Trauma (acute

2014 eMedicine.com

95. Leukemia Cutis (Diagnosis)

associated with non-melanoma skin cancer in patients with chronic lymphocytic leukemia. Dermatol Online J . 2010 Mar 15. 16(3):4. . Kaplan AL, Cook JL. Cutaneous squamous cell carcinoma in patients with chronic lymphocytic leukemia. Skinmed . 2005 Sep-Oct. 4 (5):300-4. . Fadilah SA, Alawiyah AA, Amir MA, Cheong SK. Leukaemia cutis presenting as leonine facies. Med J Malaysia . 2003 Mar. 58(1):102-4. . Heskel NS, White CR, Fryberger S, Neerhout RC, Spraker M, Hanifin JM. Aleukemic leukemia cutis: juvenile (...) paronychia. Int J Dermatol . 1985 Nov. 24(9):595-7. . Simon CA, Su WP, Li CY. Subungual leukemia cutis. Int J Dermatol . 1990 Nov. 29(9):636-9. . Beynet D, Oro AE. Leukemia cutis presenting as a Sister Mary Joseph nodule. Arch Dermatol . 2004 Sep. 140(9):1170-1. . Watanabe H, Okuyama R, Tagami H, Aiba S. Leukaemia cutis developing in a pressure ulcer. Acta Derm Venereol . 2004. 84(5):412-3. . Burns CA, Scott GA, Miller CC. Leukemia cutis at the site of trauma in a patient with Burkitt leukemia. Cutis

2014 eMedicine.com

96. Drug Eruptions (Diagnosis)

, entacapone, estrogen, furosemide, griseofulvin, influenza vaccine, penicillamine, penicillins, sertraline sulfonamides, and thiazides Photosensitivity reaction - Long-term use of voriconazole causes significantly increased photosensitivity, resulting in some patients developing squamous cell carcinoma [ ] and melanoma. [ ] Recent studies have shown dose-dependent increased risk for squamous cell carcinoma: 5.6% with each 60-day exposure at a standard dose of 200 mg twice daily. At 5 years after (...) the images below. Paronychia. Papules and annular plaques. Superficial and mid-dermal perivascular infiltrate of lymphocytes and eosinophils. Foci of extravasation of erythrocytes. Sorafenib [ ] (a novel multikinase inhibitor) - Hand-foot skin reaction, facial and scalp eruption, scalp dysesthesia, subungual splinter hemorrhages, alopecia, body hair loss, stomatitis, nipple hyperkeratosis or pain, and eruptive facial cysts Vemurafenib is a systemic medication recently approved by the Food and Drug

2014 eMedicine.com

97. Onychomatricoma (Treatment)

for classification of periungual fibrous lesions. J Dermatol . 1985 Aug. 12(4):349-56. . Baran R, Perrin C. Bowen's disease clinically simulating an onychomatricoma. J Am Acad Dermatol . 2002 Dec. 47(6):947-9. . Patel MR, Desai S. Subungual keratoacanthoma in the hand. J Hand Surg [Am] . 1989 Jan. 14(1):139-42. . Bokszczanin A, Levinson AI. Coexistent yellow nail syndrome and selective antibody deficiency. Ann Allergy Asthma Immunol . 2003 Nov. 91(5):496-500. . Wynes J, Wanat KA, Huen A, Mlodzienski AJ, Rubin AI (...) . Pigmented Onychomatricoma: A Rare Pigmented Nail Unit Tumor Presenting as Longitudinal Melanonychia That Has Potential for Misdiagnosis as Melanoma. J Foot Ankle Surg . 2015 Jul-Aug. 54 (4):723-5. . Spaccarelli N, Wanat KA, Miller CJ, Rubin AI. Hypopigmented onychocytic matricoma as a clinical mimic of onychomatricoma: clinical, intraoperative and histopathologic correlations. J Cutan Pathol . 2013 Jun. 40(6):591-4. . Kallis P, Tosti A. Onychomycosis and Onychomatricoma. Skin Appendage Disord . 2016 May

2014 eMedicine.com

98. Blue Nevi (Treatment)

, Celebi JT. B-RAF and melanocytic neoplasia. J Am Acad Dermatol . 2005 Jul. 53(1):108-14. . Van Raamsdonk CD, Bezrookove V, Green G, Bauer J, Gaugler L, O'Brien JM, et al. Frequent somatic mutations of GNAQ in uveal melanoma and blue naevi. Nature . 2009 Jan 29. 457 (7229):599-602. . Emley A, Nguyen LP, Yang S, Mahalingam M. Somatic mutations in GNAQ in amelanotic/hypomelanotic blue nevi. Hum Pathol . 2011 Jan. 42(1):136-40. . Lambert WC, Brodkin RH. Nodal and subcutaneous cellular blue nevi (...) . A pseudometastasizing pseudomelanoma. Arch Dermatol . 1984 Mar. 120(3):367-70. . Causeret AS, Skowron F, Viallard AM, Balme B, Thomas L. Subungual blue nevus. J Am Acad Dermatol . 2003 Aug. 49(2):310-2. . Di Cesare A, Sera F, Gulia A, Coletti G, Micantonio T, Fargnoli MC, et al. The spectrum of dermatoscopic patterns in blue nevi. J Am Acad Dermatol . 2011 Oct 24. . Dailey VL, Hameed O. Blue nevus of the prostate. Arch Pathol Lab Med . 2011 Jun. 135(6):799-802. . Cooper PH. Deep penetrating (plexiform spindle cell

2014 eMedicine.com

99. Paraneoplastic Diseases (Treatment)

include symmetrical, scaly, violaceous plaques on the acral surfaces, with severe forms progressing to bullae. The lesions predominantly occur on the hands, feet, ear helices, nose tip, and scalp. Skin changes may spread to involve the knees, elbows, and malar surface of the face. [ ] Bazex syndrome occurs more commonly in men older than 40 years. [ ] Alopecia and nail changes are common and can be early findings. Subungual hyperkeratosis, onychodystrophy, and white flaking of the nail surface (...) diagnosis of EMPD includes Bowen disease, amelanotic superficial spreading malignant melanoma, and eczematous dermatitis. Clinical course and prognosis Skin lesions slowly increase in size. Over time, the lesions may progress from pruritic to painful, and they may become ulcerated. Regional lymph nodes may become involved. The general course of the disease depends on the presence of an underlying internal cancer. EMPD patients have a 5-year survival rate of 72-85%. Patients with EMPD without an internal

2014 eMedicine.com

100. Verrucous Carcinoma (Treatment) (Full text)

. . Sheen MC, Sheen YS, Sheu HM, Wong TW, Lee YY, Wu CF, et al. Subungual verrucous carcinoma of the thumb treated by intra-arterial infusion with methotrexate. Dermatol Surg . 2005 Jul. 31(7 Pt 1):787-9. . Bernadas SR, Evgenios E, Dimitriadis PA, Hamal P, Uppal R. Verrucous carcinoma of the upper arm. ANZ J Surg . 2014 Dec. 84(12):983-4. . Warner CL, Cockerell CJ. The new seventh edition American Joint Committee on Cancer staging of cutaneous non-melanoma skin cancer: a critical review. Am J Clin (...) RR, Chaukar DA, Deshpande MS, et al. Verrucous carcinoma of the oral cavity: A clinical and pathological study of 101 cases. Oral Oncol . 2009 Jan. 45(1):47-51. . Terada T. Verrucous carcinoma of the skin: a report on 5 Japanese cases. Ann Diagn Pathol . 2011 Jun. 15(3):175-80. . Hagiwara H, Kanazawa T, Ishikawa K, et al. Invasive verrucous carcinoma: a temporal bone histopathology report. Auris Nasus Larynx . 2000 Apr. 27(2):179-83. . Desai A, Ugorji R, Khachemoune A. Acral melanoma foot lesions

2014 eMedicine.com PubMed

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