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JAMA Dermatology Clinicopathological Challenge
April 2014

Longitudinal Melanonychia of the Toenail

Author Affiliations
  • 1Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
JAMA Dermatol. 2014;150(4):449-450. doi:10.1001/jamadermatol.2013.8358

A man in his 60s presented with a pigmented nail streak on the left fourth toenail that had been present for 10 months. He denied pain, tenderness, or trauma. Physical examination revealed a 4-mm wide pigmented streak with varying shades of brown and longitudinal ridging (Figure, A). The nail fold was uninvolved. Because of suspicion for melanoma, a biopsy was recommended. A nail avulsion was performed and demonstrated a 3-mm tan papule beneath the proximal nail fold (Figure, B). The histologic findings are shown in Figure, C.

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