Melanocytic nevus is the most common melanocytic nail lesion in childhood (accounting for up to 75% of lesions).1,7,14,23,45,53 Clinically, it consists of a more or less regular longitudinal melanonychia.1,7,14,43,54 Melanocytic nevi, particularly congenital ones, can lead to pigmentation of the proximal nail fold (Hutchinson sign) without being suggestive of malignancy.1,7,45,54,55 At times, particularly in infancy, melanocytic nevi of the nail matrix may have an atypical clinical presentation, with broad or irregular melanonychia, Hutchinson sign not associated with melanoma, and even complete melanonychia.7,45,49,5456 Histopathologically, proliferation is observed of melanocytes arranged in nests that occupy the basal layers of the epithelium of the nail matrix.1,7,15,51,54,56 Given the firmness of the overlying nail plate, the nests can be squashed and confluent, as frequently observed in longitudinal biopsies.7 A suprabasal increase of isolated melanocytes can be observed, without any other atypical features present.1,3,79,51,56 Nail Melanoma Nail melanoma is an uncommon tumor, but diagnosis is often made late, and this partly explains its poor prognosis.1,7,34,41,42,50,51,57 In fact, the extent of invasion at diagnosis is usually significantly greater than that of surface spreading melanoma.7,8,34,41,42,57 The most frequent histopathological variant of subungual melanoma is acral lentiginous melanoma.8,16,27,42,5860 Superficial spreading melanoma and nodular melanoma occur less frequently in the nail.7,8,12,23,59,60 In absolute terms, nail melanoma has a similar incidence in different ethnic groups, but the low frequency of other types of melanoma in black and oriental patients means the percentage in these groups with respect to all types of melanoma is higher.1,3,8,14,58,6163 Nail melanoma is very infrequent in children (up to 16 years), with a median age of presentation of 7 years (range, 6 months to 16 years)
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doi:10.1016/s0140-6736(64)90011-x 12
