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Longitudinal melanonychia: when to biopsy and is dermoscopy helpful?

Authors

  • Chris Guest Adigun,

    Corresponding author
    • The Ronald O. Perelman Department of Dermatology
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  • Richard K. Scher

    Corresponding author
    1. New York University, School of Medicine, New York, New York
    2. Departments of Dermatology, Weill Cornell Medical College, New York, New York
    • The Ronald O. Perelman Department of Dermatology
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Address correspondence and reprint requests to: Chris G. Adigun, MD, Assistant Professor, The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, 240 East 38th Street 12th Floor, New York, NY 10016, or email chris.adigun@nyumc.org.

Abstract

Longitudinal melanonychia (LM) is a common presenting problem in general dermatology, and represents a diagnostic challenge to clinicians given its broad differential diagnosis that includes both benign and malignant entities. The decision of when a biopsy is required is incredibly challenging for dermatologists. Dermoscopy is a noninvasive technique that enhances the clinical evaluation of LM, and has demonstrated potential in improving the clinical decision making as to whether or not to biopsy LM. However, it is critical for clinicians to understand the limitations of dermoscopy, and that although it is able to add new criteria for the diagnosis of ungual pigmentation, it does not replace histopathologic diagnosis. Biopsy of the nail unit should be performed in any case where doubt based on the clinical evaluation exists.

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