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Subungual Melanoma

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121. Dermatologic Manifestations of Hematologic Disease (Treatment)

, 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

122. Cutaneous Melanoacanthoma (Treatment)

reflectance confocal microscopy features of a melanoacanthoma. Dermatol Pract Concept . 2016 Oct. 6 (4):27-30. . 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 (...) . Verrucous melanoma simulating melanoacanthoma: Dermoscopic, reflectance confocal microscopic and high-definition optical coherence tomography presentation of a rare melanoma variant. Australas J Dermatol . 2016 Feb. 57 (1):72-3. . Papageorgiou V, Apalla Z, Sotiriou E, Papageorgiou C, Lazaridou E, Vakirlis S, et al. The limitations of dermoscopy: false-positive and false-negative tumours. J Eur Acad Dermatol Venereol . 2018 Jan 5. . Shahriari N, Grant-Kels JM, Rabinovitz HS, Oliviero M, Scope A. In vivo

2014 eMedicine.com

123. Dermoscopy (Treatment)

Dermoscopy (Treatment) 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

124. Leukemia Cutis (Treatment)

by leukaemic cells: a case report. Acta Derm Venereol . 2001 Jun-Jul. 81(3):215-6. . Smoller BR. Leukemic vasculitis: a newly described pattern of cutaneous involvement. Am J Clin Pathol . 1997 Jun. 107(6):627-9. . Wilson ML, Elston DM, Tyler WB, Marks VJ, Ferringer T. Dense lymphocytic infiltrates 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 (...) complicated by B-cell chronic lymphocytic lymphoma. J Dermatol . 2004 Jul. 31(7):560-3. . Ferreira M, Caetano M, Amorim I, Selores M. Leukemia cutis resembling a flare-up of psoriasis. Dermatol Online J . 2006 Mar 30. 12(3):13. . High DA, Luscombe HA, Kauh YC. Leukemia cutis masquerading as chronic 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

2014 eMedicine.com

125. Onychomatricoma (Follow-up)

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

126. Neurilemoma (Follow-up)

lip: case report with distinct histologic features and review of the literature. J Oral Maxillofac Surg . 2011 Jun. 69(6):e118-22. . Kara M, Akyüz M, Yilmaz A, Hatipoglu C, 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 (...) invasive sacral schwannoma. Its clinical features and surgical management without stability. Neurosciences (Riyadh) . 2014 Jul. 19(3):224-8. . Rodríguez-Peralto JL, Riveiro-Falkenbach E, 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

2014 eMedicine.com

127. Nail Surgery (Follow-up)

is frequently used as a therapeutic adjunct in long-standing fungal infections of the nail, such as chronic onychomycosis, and in acute bacterial infections. [ , ] In traumatic nail injuries, avulsion may be used to evaluate the stability of the nail bed or to release a subungual hematoma after failed puncture aspiration. Paring the nail plate is the process of taking off pieces of the nail in a transverse or longitudinal fashion to fully observe an involved area on the nail bed. [ ] In the case of verrucae (...) of the blade must be oriented to lie directly against the undersurface of the plate and the PNF. Proximal nail avulsion is attempted when creating a cleavage plane between the nail plate and the nail bed distally is impossible because of the presence of distal nail dystrophy, which prevents access to the distal free edge of the nail plate. This presentation may be seen in distal subungual onychomycosis. [ , , ] First, the Freer elevator is inserted beneath the cuticle in the proximal groove to separate

2014 eMedicine.com

128. Pyogenic Granuloma (Lobular Capillary Hemangioma) (Follow-up)

. Treatment options for cutaneous pyogenic granulomas: a review. J Plast Reconstr Aesthet Surg . 2011 Sep. 64(9):1216-20. . Piraccini BM, Bellavista S, Misciali C, Tosti A, de Berker D, Richert B. Periungual and subungual pyogenic granuloma. Br J Dermatol . 2010 Nov. 163(5):941-53. . Rodins K, Gramp D, James D, Kumar S. Pyogenic granuloma, port-wine stain and pregnancy. Australas J Dermatol . 2011 Nov. 52(4):e8-e10. . Cheah S, DeKoven J. Pyogenic granuloma complicating pulsed-dye laser therapy for cherry (...) . Case reports: mitozantrone-induced onycholysis associated with subungual abscesses, paronychia, and pyogenic granuloma. J Drugs Dermatol . 2005 Jul-Aug. 4(4):490-2. . Devillers C, Vanhooteghem O, Henrijean A, Ramaut M, de la Brassinne M. Subungueal pyogenic granuloma secondary to docetaxel therapy. Clin Exp Dermatol . 2009 Mar. 34(2):251-2. . Paul LJ, Cohen PR. Paclitaxel-associated subungual pyogenic granuloma: report in a patient with breast cancer receiving paclitaxel and review of drug-induced

2014 eMedicine.com

129. Paraneoplastic Diseases (Follow-up)

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

130. Leukemia Cutis (Follow-up)

by leukaemic cells: a case report. Acta Derm Venereol . 2001 Jun-Jul. 81(3):215-6. . Smoller BR. Leukemic vasculitis: a newly described pattern of cutaneous involvement. Am J Clin Pathol . 1997 Jun. 107(6):627-9. . Wilson ML, Elston DM, Tyler WB, Marks VJ, Ferringer T. Dense lymphocytic infiltrates 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 (...) complicated by B-cell chronic lymphocytic lymphoma. J Dermatol . 2004 Jul. 31(7):560-3. . Ferreira M, Caetano M, Amorim I, Selores M. Leukemia cutis resembling a flare-up of psoriasis. Dermatol Online J . 2006 Mar 30. 12(3):13. . High DA, Luscombe HA, Kauh YC. Leukemia cutis masquerading as chronic 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

2014 eMedicine.com

131. Keratosis Palmaris et Plantaris (Follow-up)

psoriasislike plaques or lichenoid patches may be present on the knees and the elbows. Patients may have severe hyperhidrosis, possibly accompanied by malodor. Secondary bacterial and fungal infections are common. Perioral erythema; periorbital erythema and hyperkeratosis; nail changes (eg, koilonychia, subungual hyperkeratosis); and lingua plicata, syndactyly, hair on the palms and the soles, high-arched palate, and left-handedness are other clinical features. Histologic findings include orthokeratosis (...) on the affected genes. Onset occurs in the first year of life. Clinically, PPK begins focally in infancy and then becomes diffuse and severe. Later findings include flexion deformities and constriction of the digits, sometimes leading to spontaneous amputation. Progressive, well-defined perioral, perianal, and perineal hyperkeratotic plaques are present, as is onychodystrophy. Alopecia, deafness, nail dystrophy, and dental loss may be associated. Squamous cell carcinoma and malignant melanoma have developed

2014 eMedicine.com

132. Melanonychia (Follow-up)

of the distal phalanx may be indicated. [ ] Albeit controversial, total nail bed excision and reconstruction using a full-thickness graft may be considered. In a large case series, the 5-year survival rates for cutaneous melanoma of the hand versus subungual melanoma treated with a wide local excision was reported as 100% and 80%, respectively. [ ] . This was due to a delay in diagnosing subungual lesions, which averaged 3.68 mm in depth versus 1.36 mm for hand melanomas of the cutaneous surface. Because (...) diagnosis is often delayed in these patients, sentinel lymph node biopsy after surgery may be warranted. [ ] Previous Next: Consultations Because longitudinal melanonychia is associated with a variety of systemic conditions, these cases may require referral to the appropriate specialist in order to manage the primary disease. In cases of subungual melanoma with a poor prognosis, consultation with a hematologist/oncologist regarding potential chemotherapeutic options may be warranted. Previous Next

2014 eMedicine.com

133. Dermatologic Manifestations of Hematologic Disease (Follow-up)

, 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

134. Cutaneous Melanoacanthoma (Follow-up)

reflectance confocal microscopy features of a melanoacanthoma. Dermatol Pract Concept . 2016 Oct. 6 (4):27-30. . 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 (...) . Verrucous melanoma simulating melanoacanthoma: Dermoscopic, reflectance confocal microscopic and high-definition optical coherence tomography presentation of a rare melanoma variant. Australas J Dermatol . 2016 Feb. 57 (1):72-3. . Papageorgiou V, Apalla Z, Sotiriou E, Papageorgiou C, Lazaridou E, Vakirlis S, et al. The limitations of dermoscopy: false-positive and false-negative tumours. J Eur Acad Dermatol Venereol . 2018 Jan 5. . Shahriari N, Grant-Kels JM, Rabinovitz HS, Oliviero M, Scope A. In vivo

2014 eMedicine.com

135. Cutaneous Manifestations of HIV Disease (Follow-up)

. 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

136. Dermoscopy (Follow-up)

Dermoscopy (Follow-up) 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

137. Verrucous Carcinoma (Follow-up)

. . 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

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2014 eMedicine.com

138. Hand, Paronychia Drainage

: 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

139. Paronychia (Treatment)

: 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 Emergency Medicine

140. Neurilemoma (Diagnosis)

, 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

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