Case and research letter
Congenital Subungual and Periungual Melanocytic Nevus
Nevus melanocítico congénito subungueal y periungueal
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Agusti-Mejias, F. Messeguer, I. Febrer, V. Alegre" "autores" => array:4 [ 0 => array:3 [ "nombre" => "A." "apellidos" => "Agusti-Mejias" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "F." "apellidos" => "Messeguer" "email" => array:1 [ 0 => "francescmb@comv.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "I." "apellidos" => "Febrer" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "V." "apellidos" => "Alegre" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital General Universitario de Valencia, Valencia, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Nevus melanocítico congénito subungueal y periungueal" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 499 "Ancho" => 1400 "Tamanyo" => 86324 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A, The initial dermoscopy revealed the presence of pigmented globules in the nail plate and in the proximal periungual skin. B, Two months later, pigmented globules were visible on a brown background, with narrow and regular longitudinal lines in the nail plate. C, At 6 months the dermoscopic pattern was unchanged.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A healthy newborn infant aged 12<span class="elsevierStyleHsp" style=""></span>hours, of Ecuadorian origin and with no family history of melanoma or other tumors of interest, was referred for evaluation of a congenital lesion of the nail of the third finger of the left hand. The infant had not suffered any birth or postnatal trauma to the affected finger.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Physical examination showed practically the whole nail surface to be a homogeneous erythematous-brown color (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). Dermoscopy revealed black globules arranged linearly on the brown background of the nail plate and a marked gray periungual pigmentation with brown globules (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A). Correlation of the clinical and dermoscopic findings suggested melanocytic nevus of the nail matrix as the most likely diagnosis, although other melanocytic lesions or hemorrhage could not be excluded at that time. Given the apparent benign nature of the lesion, it was decided to keep the infant under close observation.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Two months later the pigmented area had spread beyond the borders of the nail plate and there was clear involvement of the periungual skin (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). Dermoscopy of this new situation revealed pigmented globules on a light-brown background in the periungual skin, narrow and regular longitudinal lines in the nail plate, and globules of black pigment most numerous in the distal third of the plate (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>B).</p><p id="par0020" class="elsevierStylePara elsevierViewall">Punch biopsy of the hyponychium was performed and histology revealed a junctional melanocytic proliferation of benign appearance, with melanocytes grouped in nests and as isolated cells in the epidermis (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). Histology of a distal fragment of the nail plate showed deposits of melanin. The final diagnosis was periungual and subungual congenital melanocytic nevus (CMN). After 6 months of follow-up the periungual component of the nevus had become more evident but the size of the lesion was unchanged (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C and <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>C).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Periungual and subungual CMN is a very rare entity, with only 2 previous descriptions in the literature.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The lesion presents clinically as a homogeneous pigmentation of the nail plate. Usually it increases in size to affect the periungual skin, a finding that supports the diagnosis of a pigmented melanocytic lesion. Our case is the first in which the dermoscopic features of this type of lesion have been reported; the dermoscopic pattern is similar to that of CMNs at other sites, with pigmented globules of irregular size and distribution clearly visible on a background of homogeneous pigmentation.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> The total melanonychia and the presence of globules in subungual CMNs are due to participation of the nail bed epidermis in the formation of part of the nail plate. The narrow longitudinal lines can be explained by involvement of the nail matrix.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">In contrast to the usual histopathological features of CMNs, in which the dermal component predominates, subungual and periungual CMNs are characterized mainly by junctional melanocytic proliferations. In our case there were also isolated intraepidermal melanocytes.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The differential diagnosis must include disorders of various origins, including melanocytic lesions (ungual lentigo, nevus of the nail matrix, subungual blue nevus, ungual melanoma), racial pigmentation, drug-induced pigmentation, endocrine disorders, trauma, and hemorrhage.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Histology of the nail plate is a simple and nontraumatic way to differentiate between melanic and hematic origins of the pigment deposits in the nail. In subungual CMNs, the early presence of proximal periungual pigment may be erroneously interpreted as a positive Hutchinson or pseudo-Hutchinson sign, observed respectively in acral melanomas and nail matrix nevus.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> However, the absence of mottled striate melanonychia and the presence of pigmented globules are features more commonly associated with a diagnosis of CMN.</p><p id="par0045" class="elsevierStylePara elsevierViewall">It is often impossible to exclude melanoma histologically in acral and subungual melanocytic lesions, particularly in children, due either to the use of partial biopsies or the unusual characteristics of acral melanocytic nevi in children, which can present isolated nuclear atypia and even a pagetoid distribution of some of the melanocytes.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> In cases of melanonychia in which malignancy is suspected (a broad band of pigment, Hutchinson sign, irregular dermoscopic features, a dark-skinned patient), the lesion must therefore be completely excised.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7,8</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">The management of pigmented nail lesions will therefore depend on whether the rare but very serious childhood acral lentiginous melanoma is suspected.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9,10</span></a> Dermoscopic and clinical follow-up should be reserved for lesions with low-risk features (narrow bands, uniform dermoscopic characteristics, no changes over time). In such cases, meticulous periodic follow-up (by dermoscopy and a photographic record) would appear to be the most suitable option, as it would avoid the potential cosmetic and functional sequelae of excision or biopsy.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,7,8</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">In conclusion, we have presented the third case of subungual and periungual CMN to be reported in the literature. Knowledge of this entity can help to prevent aggressive treatments (wide excision, amputation) due to the overdiagnosis of childhood acral lentiginous melanoma.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Agusti-Mejias A, et al. Nevus melanocítico congénito subungueal y periungueal. Actas Dermosi-filiogr. 2013;104:446-8.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 497 "Ancho" => 1400 "Tamanyo" => 90207 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Initial clinical photograph showing homogeneous brown melanonychia. B, Two months later the periungual alterations were clearly visible. C, After 6 months of follow-up, the periungual component had become more pronounced.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 499 "Ancho" => 1400 "Tamanyo" => 86324 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A, The initial dermoscopy revealed the presence of pigmented globules in the nail plate and in the proximal periungual skin. B, Two months later, pigmented globules were visible on a brown background, with narrow and regular longitudinal lines in the nail plate. C, At 6 months the dermoscopic pattern was unchanged.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 673 "Ancho" => 900 "Tamanyo" => 292773 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Epidermal hyperplasia and a proliferation of melanocytes with small nuclei and no atypia or pleomorphism; the melanocytes were arranged in nests of different sizes in the deep part of the epithelium and also as individual cells with a pagetoid distribution in the superficial layers of the epithelium (hematoxylin-eosin, original magnification x100).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Congenital subungual nevus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R.J. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 17 | 11 | 28 |
| 2024 Octubre | 85 | 35 | 120 |
| 2024 Septiembre | 64 | 25 | 89 |
| 2024 Agosto | 128 | 84 | 212 |
| 2024 Julio | 105 | 29 | 134 |
| 2024 Junio | 118 | 43 | 161 |
| 2024 Mayo | 99 | 37 | 136 |
| 2024 Abril | 96 | 34 | 130 |
| 2024 Marzo | 95 | 38 | 133 |
| 2024 Febrero | 75 | 31 | 106 |
| 2024 Enero | 127 | 52 | 179 |
| 2023 Diciembre | 81 | 45 | 126 |
| 2023 Noviembre | 93 | 54 | 147 |
| 2023 Octubre | 93 | 56 | 149 |
| 2023 Septiembre | 109 | 53 | 162 |
| 2023 Agosto | 77 | 38 | 115 |
| 2023 Julio | 120 | 61 | 181 |
| 2023 Junio | 76 | 36 | 112 |
| 2023 Mayo | 82 | 23 | 105 |
| 2023 Abril | 76 | 31 | 107 |
| 2023 Marzo | 59 | 23 | 82 |
| 2023 Febrero | 63 | 40 | 103 |
| 2023 Enero | 50 | 39 | 89 |
| 2022 Diciembre | 60 | 43 | 103 |
| 2022 Noviembre | 33 | 43 | 76 |
| 2022 Octubre | 53 | 43 | 96 |
| 2022 Septiembre | 57 | 62 | 119 |
| 2022 Agosto | 46 | 40 | 86 |
| 2022 Julio | 40 | 38 | 78 |
| 2022 Junio | 44 | 35 | 79 |
| 2022 Mayo | 86 | 51 | 137 |
| 2022 Abril | 81 | 42 | 123 |
| 2022 Marzo | 99 | 56 | 155 |
| 2022 Febrero | 102 | 38 | 140 |
| 2022 Enero | 102 | 49 | 151 |
| 2021 Diciembre | 110 | 57 | 167 |
| 2021 Noviembre | 91 | 57 | 148 |
| 2021 Octubre | 93 | 68 | 161 |
| 2021 Septiembre | 65 | 68 | 133 |
| 2021 Agosto | 97 | 47 | 144 |
| 2021 Julio | 75 | 45 | 120 |
| 2021 Junio | 114 | 60 | 174 |
| 2021 Mayo | 112 | 52 | 164 |
| 2021 Abril | 137 | 65 | 202 |
| 2021 Marzo | 87 | 42 | 129 |
| 2021 Febrero | 60 | 36 | 96 |
| 2021 Enero | 44 | 34 | 78 |
| 2020 Diciembre | 41 | 23 | 64 |
| 2020 Noviembre | 37 | 31 | 68 |
| 2020 Octubre | 28 | 23 | 51 |
| 2020 Septiembre | 52 | 14 | 66 |
| 2020 Agosto | 28 | 29 | 57 |
| 2020 Julio | 32 | 28 | 60 |
| 2020 Junio | 30 | 35 | 65 |
| 2020 Mayo | 25 | 50 | 75 |
| 2020 Abril | 27 | 32 | 59 |
| 2020 Marzo | 26 | 36 | 62 |
| 2020 Febrero | 3 | 17 | 20 |
| 2020 Enero | 4 | 27 | 31 |
| 2019 Diciembre | 8 | 19 | 27 |
| 2019 Noviembre | 4 | 6 | 10 |
| 2019 Octubre | 0 | 28 | 28 |
| 2019 Septiembre | 4 | 25 | 29 |
| 2019 Agosto | 4 | 11 | 15 |
| 2019 Julio | 4 | 34 | 38 |
| 2019 Junio | 4 | 20 | 24 |
| 2019 Mayo | 7 | 54 | 61 |
| 2019 Abril | 3 | 36 | 39 |
| 2019 Marzo | 4 | 13 | 17 |
| 2019 Febrero | 2 | 9 | 11 |
| 2019 Enero | 4 | 12 | 16 |
| 2018 Diciembre | 2 | 4 | 6 |
| 2018 Noviembre | 1 | 9 | 10 |
| 2018 Octubre | 5 | 0 | 5 |
| 2018 Septiembre | 4 | 3 | 7 |
| 2018 Agosto | 0 | 11 | 11 |
| 2018 Julio | 0 | 12 | 12 |
| 2018 Junio | 0 | 7 | 7 |
| 2018 Mayo | 0 | 9 | 9 |
| 2018 Abril | 0 | 3 | 3 |
| 2018 Marzo | 9 | 7 | 16 |
| 2018 Febrero | 53 | 11 | 64 |
| 2018 Enero | 77 | 18 | 95 |
| 2017 Diciembre | 82 | 9 | 91 |
| 2017 Noviembre | 82 | 10 | 92 |
| 2017 Octubre | 81 | 12 | 93 |
| 2017 Septiembre | 70 | 25 | 95 |
| 2017 Agosto | 76 | 14 | 90 |
| 2017 Julio | 63 | 14 | 77 |
| 2017 Junio | 71 | 23 | 94 |
| 2017 Mayo | 113 | 21 | 134 |
| 2017 Abril | 59 | 10 | 69 |
| 2017 Marzo | 63 | 30 | 93 |
| 2017 Febrero | 152 | 12 | 164 |
| 2017 Enero | 52 | 19 | 71 |
| 2016 Diciembre | 90 | 20 | 110 |
| 2016 Noviembre | 108 | 23 | 131 |
| 2016 Octubre | 118 | 19 | 137 |
| 2016 Septiembre | 206 | 20 | 226 |
| 2016 Agosto | 124 | 16 | 140 |
| 2016 Julio | 66 | 6 | 72 |
| 2016 Junio | 11 | 23 | 34 |
| 2016 Mayo | 13 | 8 | 21 |
| 2016 Abril | 5 | 19 | 24 |
| 2016 Marzo | 3 | 1 | 4 |
| 2016 Febrero | 5 | 1 | 6 |
| 2016 Enero | 6 | 1 | 7 |
| 2015 Diciembre | 4 | 1 | 5 |
| 2015 Noviembre | 25 | 10 | 35 |
| 2015 Octubre | 29 | 5 | 34 |
| 2015 Septiembre | 16 | 1 | 17 |
| 2015 Agosto | 9 | 9 | 18 |
| 2015 Julio | 107 | 1 | 108 |
| 2015 Junio | 85 | 10 | 95 |
| 2015 Mayo | 98 | 8 | 106 |
| 2015 Abril | 76 | 3 | 79 |
| 2015 Marzo | 74 | 3 | 77 |
| 2015 Febrero | 65 | 6 | 71 |
| 2015 Enero | 75 | 5 | 80 |
| 2014 Diciembre | 53 | 4 | 57 |
| 2014 Noviembre | 53 | 7 | 60 |
| 2014 Octubre | 67 | 8 | 75 |
| 2014 Septiembre | 48 | 7 | 55 |
| 2014 Agosto | 42 | 7 | 49 |
| 2014 Julio | 47 | 8 | 55 |
| 2014 Junio | 58 | 4 | 62 |
| 2014 Mayo | 52 | 10 | 62 |
| 2014 Abril | 55 | 6 | 61 |
| 2014 Marzo | 63 | 10 | 73 |
| 2014 Febrero | 61 | 7 | 68 |
| 2014 Enero | 49 | 9 | 58 |
| 2013 Diciembre | 56 | 9 | 65 |
| 2013 Noviembre | 41 | 5 | 46 |
| 2013 Octubre | 53 | 3 | 56 |
| 2013 Septiembre | 41 | 3 | 44 |
| 2013 Agosto | 47 | 6 | 53 |
| 2013 Julio | 21 | 2 | 23 |
| 2013 Junio | 4 | 1 | 5 |
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