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March 1991

Evaluation and Management of Melanonychia Striata in a Patient Receiving Phototherapy

Author Affiliations

Columbia Presbyterian Medical Center, New York, NY

Arch Dermatol. 1991;127(3):319-320. doi:10.1001/archderm.1991.01680030031004

REPORT OF A CASE  A 73-year-old white man presented to our dermatology service in 1982 with a 40-year history of psoriasis. His medical history was significant for hypertension, which was managed with propranolol and furosemide. He was also treated with indomethacin for arthritis. Prior treatment for psoriasis included only topical corticosteroids and emollients, and this regimen failed ultimately to manage his disease adequately. It was decided to begin the Goeckerman regimen, and this patient's psoriasis rapidly cleared. Over the ensuing years, UV-B therapy was used sporadically for maintenance.In November 1985, a solitary pigmented nail streak was noted for the first time on the left index finger. A 2-mm punch biopsy specimen of the nail matrix revealed a subungual melanoma, and a matricectomy was subsequently performed (Fig 1). Healing occurred without complication.In July 1986, the patient experienced a flare of his psoriasis, and phototherapy was restarted. A new pigmented

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