Macroscopic and dermoscopic evaluation used to differentiate subungual haemorrhage from melanocytic lesions
Mirain Phillips 1 2 , Amanda Oakley 11 Department of Dermatology, Waikato Hospital, Waikato District Health Board, Hamilton, New Zealand
2 Corresponding author. Email: mirain.phillips@sky.com
Journal of Primary Health Care 12(4) 368-372 https://doi.org/10.1071/HC20092
Published: 17 December 2020
Journal Compilation © Royal New Zealand College of General Practitioners 2020 This is an open access article licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License
Abstract
INTRODUCTION: Subungual haemorrhage describes blood located between the nail matrix and nail plate caused by trauma. Lack of recalled trauma and long duration of nail pigmentation results in specialist referrals to rule out malignant pathology.
AIM: This report aims to describe the macroscopic and dermoscopic characteristics of subungual haemorrhage and to highlight its clinical differentiation from melanocytic lesions.
METHODS: Ninety-eight nails were assessed. Pigmentation in fifty-nine was due to subungual haemorrhage and was melanocytic in the remainder (identified by a longitudinal pigmented band).
RESULTS: Pigmentation in subungual haemorrhage had a clear proximal margin (73%) and the dermoscopic pattern was homogenous (97%), globular (78%) or streaky (34%). Features included peripheral fading (68%) and periungual haemorrhage (5%). Malignancy could be excluded in these cases by careful clinical evaluation.
DISCUSSION: A combination of macroscopic and dermoscopic characteristics help make a confident diagnosis of subungual haemorrhage. A two-stage process can aid clinical diagnosis by looking for known features of subungual haemorrhage and identifying absence of malignant features.
Keywords: Subungual haematoma; melanonychia; ungual melanoma; nail diseases; pigmentation disorders; dermoscopy; diagnosis; differential
References
[1] Nevares-Pomales OW, Sarriera-Lazaro C, Barrera-Llaurador J, et al. Pigmented lesions of the nail unit. Am J Dermatopathol. 2018; 40 793–804.| Pigmented lesions of the nail unit.Crossref | GoogleScholarGoogle Scholar | 30339563PubMed |
[2] Alessandrini A, Starace M, Piraccini B. Dermoscopy in the evaluation of nail disorders. Skin Appendage Disord. 2017; 3 70–82.
| Dermoscopy in the evaluation of nail disorders.Crossref | GoogleScholarGoogle Scholar | 28560217PubMed |
[3] Mun JH, Kim G, Jwa S, et al. Dermoscopy of subungual haemorrhage: its usefulness in differential diagnosis from nail-unit melanoma. Br J Dermatol. 2013; 168 1224–9.
| Dermoscopy of subungual haemorrhage: its usefulness in differential diagnosis from nail-unit melanoma.Crossref | GoogleScholarGoogle Scholar | 23302009PubMed |
[4] Koga H, Saida T, Uhara H. Key point in dermoscopic differentiation between early nail apparatus melanoma and benign longitudinal melanonychia. J Dermatol. 2011; 38 45–52.
| Key point in dermoscopic differentiation between early nail apparatus melanoma and benign longitudinal melanonychia.Crossref | GoogleScholarGoogle Scholar | 21175755PubMed |
[5] Phan A, Dalle S, Touzet S, et al. Dermoscopic features of acral lentiginous melanoma in a large series of 110 cases in a white population. Br J Dermatol. 2009; 162 765–71.
| Dermoscopic features of acral lentiginous melanoma in a large series of 110 cases in a white population.Crossref | GoogleScholarGoogle Scholar | 19922528PubMed |
[6] Benati E, Ribero S, Longo C, et al. Clinical and dermoscopic clues to differentiate pigmented nail bands: an International Dermoscopy Society study. J Eur Acad Dermatol Venereol. 2016; 31 732–6.
| Clinical and dermoscopic clues to differentiate pigmented nail bands: an International Dermoscopy Society study.Crossref | GoogleScholarGoogle Scholar | 27696528PubMed |
[7] Fountain JA. Recognition of subungual hematoma as an imitator of subungual melanoma. J Am Acad Dermatol. 1990; 23 773–4.
| Recognition of subungual hematoma as an imitator of subungual melanoma.Crossref | GoogleScholarGoogle Scholar | 2229520PubMed |
[8] Thomas L, Dalle S. Dermoscopy provides useful information for the management of melanonychia striata. Dermatol Ther. 2007; 20 3–10.
| Dermoscopy provides useful information for the management of melanonychia striata.Crossref | GoogleScholarGoogle Scholar | 17403255PubMed |
