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The Best of the Best
June 2012

Top Accessed Article: Dermoscopic Examination of Nail Pigmentation

Arch Dermatol. 2012;148(6):752. doi:10.1001/archdermatol.2012.394

Ronger S, Touzet S, Ligeron C, et al. Dermoscopic examination of nail pigmentation. Arch Dermatol. 2002;138(10):1327-1333.

Accurate diagnosis of nail pigmentation can be a challenge. In the above article, Ronger and colleagues describe the dermoscopic features that are associated with melanoma, melanocytic nevus, ungula lentigo, drug-induced pigmentation, and subungal hemorrhage. For nail apparaturs melanoma, the most useful diagnostic criterion is the presence of irregularly colored line areas, with nonuniformed spacing between the lines and disruption of parallelism. In contrast, melanocytic nevus has lines that are regular in thickness, spacing, color, and parallelism. The main features of drug-induced pigmentation are a grayish coloration of the background and the presence of thin gray lines with regular thickness. Subungal hemorrhage can be recognized by the presence of blue to black structureless blood spots with rounded edges. These blood spots are commonly found in the periphery of the pigmentation. Armed with these specific dermoscopic patterns and clues, clinicians can increase the diagnostic accuracy of nail pigmentations that are associated with benign and malignant lesions. Finally, it is important to emphasize that dermoscopic examination does not replace histologic diagnosis. Biopsy should be performed in cases involving suspicious lesions.

From October 2010 to August 2011, this article was viewed 1915 times on the Archives of Dermatology Web site.

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Contact Dr Wang at the Dermatology Division, Memorial Sloan Kettering Cancer Center, New York, New York (wangs@mskcc.org).

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