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Subungual Pigmented Nevus. Presented by Dr. Allen E. Walker and Dr. John J. Stewart.
Dr. E. A., a 52-year-old white man, a dentist, first noted the onset of a brownish discoloration of the nail plate of the left thumb approximately two years ago. It gradually has become more extensive, and the central area developed a separation of the nail plate from the bed, with splitting of the nail, forming a V-shaped deformity at the peripheral central border. At no time has there been any discomfort associated with the lesion. The patient recalls no trauma to the nail or any infection. The past history is essentially noncontributory.
The nail plate shows a brownish-black discoloration, extending from the ridge to the distal border. It is sharply demarcated and seems primarily to involve the lateral half of the nail. The central portion of the distal nail plate is notched. There appears to