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Chapter 33: Melanonychia

INTRODUCTION

KEY POINTS

  • Longitudinal melanonychia (LM) is a benign presentation of vertical pigmented streaks on the nail plate that typically range in color from tan to dark brown.

  • LM is more common in skin of color, and those with melanonychia should be evaluated to rule out acral melanoma.

  • Its presence in multiple digits can help confirm the diagnosis of melanonychia and decreases the likelihood of melanoma.

image

FIGURE 33-1.

Dark-brown linear streak with darker central pigmentation, secondary to a matrix lentigo, extending along the full length of the lateral nail plate of a dark-skinned individual. (Reproduced with permission from Kang S, Amagai M, Bruckner AL, et al. Fitzpatrick’s Dermatology, 9th ed. New York, NY: McGraw Hill; 2019, Figure 91-82.)

A photo depicts melanonychia of the finger nail caused by a matrix lentigo.
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FIGURE 33-2.

Light-brown–gray linear streak located centrally on the nail plate of the great toe of a person with light skin. (Reproduced with permission from Taylor SC, Kelly AP, Lim HW, et al. Taylor and Kelly’s Dermatology for Skin of Color, 2nd ed. New York, NY: McGraw Hill; 2016, Figure 40-2.)

A light skinned person exhibits a vertical pale brown streak at the center of the nail plate of the great toe.
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FIGURE 33-3.

Faint light-brown central linear streak on the nail plate of a dark-skinned person, demonstrating the variability in the intensity of color that can be seen in people with dark skin. (Reproduced with permission from Taylor SC, Kelly AP, Lim HW, et al. Taylor and Kelly’s Dermatology for Skin of Color, 2nd ed. New York, NY: McGraw Hill; 2016, Figure 21-3.)

A person with dark brown skin exhibits a pale brown vertical streak at the center of the nail plate.
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FIGURE 33-4.

Tan linear streak extending the full length of the nail plate on a person with lighter skin. (Reproduced with permission from Prose NS, Kristal L. Weinberg’s Color Atlas of Pediatric Dermatology, 5th ed. New York, NY: McGraw Hill; 2017, Figure 26-11.)

A light skinned person exhibits a hyperpigmented vertical brown streak across the center of the nail plate.
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