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"tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "573" "paginaFinal" => "575" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Is Hutchinson's Sign Pathogonomic of Subungual Melanoma?" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figura 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 675 "Ancho" => 900 "Tamanyo" => 113692 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Hematoxilina-eosina<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>400. Epitelio escamoso acantótico con maduración celular adecuada, con melanosis epitelial basal y aislados melanófagos en estroma, sin proliferación melanocítica.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "V. Catalán, M. Yagnam, C. Morales, M. Villagra" "autores" => array:4 [ 0 => array:2 [ "nombre" => "V." "apellidos" => "Catalán" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Yagnam" ] 2 => array:2 [ "nombre" => "C." "apellidos" => "Morales" ] 3 => array:2 [ "nombre" => "M." "apellidos" => "Villagra" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1578219018301719" "doi" => "10.1016/j.adengl.2018.05.013" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219018301719?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731017305574?idApp=UINPBA000044" "url" => "/00017310/0000010900000006/v1_201808010427/S0001731017305574/v1_201808010427/es/main.assets" ] ] "itemAnterior" => array:19 [ "pii" => "S1578219018301756" "issn" => "15782190" "doi" => "10.1016/j.adengl.2018.05.017" "estado" => "S300" "fechaPublicacion" => "2018-07-01" "aid" => "1824" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2018;109:570-3" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 17 "formatos" => array:2 [ "HTML" => 15 "PDF" => 2 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>" "titulo" => "Value of Ultrasound as a Diagnostic Tool for a Painful Thoracic Nodule" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "570" "paginaFinal" => "573" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Utilidad de la ecografía en el diagnóstico diferencial de un nódulo doloroso en el tórax" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 698 "Ancho" => 1996 "Tamanyo" => 215763 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Dermatoscopy (DermLite II Pro HR, 3<span class="elsevierStyleHsp" style=""></span>Gen): central blue-violaceous area surrounded by an erythematous halo. B, Well-differentiated polylobulated tumor in the dermis (hematoxylin-eosin, original magnification<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>2). C, The tumor is composed of a biphasic epithelial proliferation comprising small cells arranged around cells with more abundant and clearer cytoplasm that forms ductal structures. No atypia or mitosis is visible (hematoxylin-eosin, original magnification<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>20).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "D. Morgado-Carrasco, S. Gómez, L. Alós, P. Giavedoni" "autores" => array:4 [ 0 => array:2 [ "nombre" => "D." "apellidos" => "Morgado-Carrasco" ] 1 => array:2 [ "nombre" => "S." "apellidos" => "Gómez" ] 2 => array:2 [ "nombre" => "L." "apellidos" => "Alós" ] 3 => array:2 [ "nombre" => "P." "apellidos" => "Giavedoni" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731017305586" "doi" => "10.1016/j.ad.2017.09.010" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731017305586?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219018301756?idApp=UINPBA000044" "url" => "/15782190/0000010900000006/v1_201808010420/S1578219018301756/v1_201808010420/en/main.assets" ] "en" => array:16 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>" "titulo" => "Is Hutchinson's Sign Pathognomic of Subungual Melanoma?" "tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">To the Editor:</span>" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "573" "paginaFinal" => "575" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "V. Catalán, M. Yagnam, C. Morales, M. Villagra" "autores" => array:4 [ 0 => array:4 [ "nombre" => "V." "apellidos" => "Catalán" "email" => array:1 [ 0 => "dravcatalan@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "M." "apellidos" => "Yagnam" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "C." "apellidos" => "Morales" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "M." "apellidos" => "Villagra" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Clínico Universidad de Chile, Santiago, Chile" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Dermatología, Universidad de Chile, Santiago, Chile" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Clínico Universidad de Chile, Santiago, Chile" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Facultad de Medicina, Universidad de Chile, Santiago, Chile" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "¿Es el signo de Hutchinson patognomónico de melanoma subungueal?" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 675 "Ancho" => 900 "Tamanyo" => 113859 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Acanthotic squamous epithelium with adequate cell maturation, epithelial melanosis in the basal layer, and isolated melanophages in the stroma. Note the absence of melanocytic proliferation (hematoxylin-eosin, original magnification ×<span class="elsevierStyleHsp" style=""></span>400).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Longitudinal melanonychia is characterized by the presence of light to dark brown or black pigmentation of the nail plate. It occurs in individuals of certain racial origins, such as blacks, Latin Americans, and Asians, but it can also be induced by trauma or drug therapy or found in benign conditions such as infections and melanocytic lesions (e.g., nail apparatus lentigo and nevi). It is also a feature of subungual melanoma. Subungual melanoma is a rare malignancy that accounts for approximately 0.7% to 3.5% of all melanomas in the general population.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Dermoscopy is a useful tool for the differential diagnosis of longitudinal melanonychia.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> One of the hallmark signs of subungual melanoma is the Hutchinson sign, which describes periungual pigmentation of the nail folds and hyponychium.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3,4</span></a> The sign has traditionally been associated with poor prognosis in subungual melanoma as it indicates radial growth. Not all Hutchinson signs, however, are associated with subungual melanoma. Some individuals may have a pseudo-Hutchinson sign, which refers to the presence of a dark pigment made visible through a translucent cuticle.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4,5</span></a> In addition, patients with benign melanocytic lesions, such as congenital nevi, may also have periungual pigmentation of the nail folds, raising suspicion of subungual melanoma<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6–8</span></a> even though this tumor is very rare in the pediatric population.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Case Description</span><p id="par0010" class="elsevierStylePara elsevierViewall">A 25-year-old woman presented with longitudinal melanonychia on her right index finger. The pigmentation had been present since the patient was 8 years old and had not changed in appearance. The patient had Fitzpatrick type III skin and the physical examination showed a dark brown band measuring 2<span class="elsevierStyleHsp" style=""></span>mm in width on the right index finger. There was also a notable Hutchinson sign (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The dermoscopic examination showed brown parallel bands along the length of the nail plate and the Hutchinson sign in the proximal and lateral folds (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). An excisional biopsy of the nail matrix and affected folds showed a mildly acanthotic squamous epithelium with preserved epithelial maturation and epithelial melanosis in the basal layer, but no evidence of lentiginous melanocytic proliferation or melanocyte nests. Periodic acid-Schiff staining was negative and there were no signs of hemorrhage (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). The findings were consistent with nail apparatus lentigo. The functional and cosmetic results after just a few months were satisfactory.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Discussion</span><p id="par0015" class="elsevierStylePara elsevierViewall">Determining the benign or malignant nature of melanonychia is challenging and requires 3 steps, the first of which is to determine whether the pigment is melanin. If it is, the second step is to discover whether the increase in melanin is due to melanocytic activation or proliferation. Dermoscopically, gray homogeneous bands suggest activation, while brown or black bands suggest proliferation.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> The third step is to determine whether the melanocytic proliferation corresponds to a benign condition (acquired, congenital, or lentiginous nevi) or a malignant one (subungual melanoma). Signs that suggest subungual melanoma include a loss of parallelism, progressive thickening of the nail band, heterogeneous pigmentation, Hutchinson sign, and nail dystrophy.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> The problem is when a patient has melanonychia with benign features and the Hutchinson sign.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Intraoperative nail matrix dermoscopy has identified dermoscopic patterns that correlate strongly with certain benign lesions and melanoma, and while still in its infancy, this diagnostic modality could be clinically useful in the future.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The Hutchinson sign, which was first described in 1886, has always been considered to be strongly suggestive for subungual melanoma. False positives, however, are relatively common and are seen in benign conditions such as Peutz-Jeghers and Laugier-Hunziker syndrome, radiation therapy, drug therapy (minocycline), trauma-induced injuries, congenital nevi, ethnic pigmentation, and systemic diseases, such as hyperthyroidism, Cushing syndrome, and deposition disorders.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2,3</span></a> Congenital nevi may also exhibit signs of malignancy, such as the Hutchinson sign and progressive darkening and thickening of the nail band.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6–8</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Our patient had had longitudinal melanonychia since childhood and had experienced no changes. We performed a biopsy because of the Hutchinson sign, even though the dermoscopic image showed a parallel lesion with uniform coloring (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). It is important to note that the Hutchinson sign is not considered pathognomonic for melanoma and this is particularly true for children, where clinical and dermoscopic criteria have not been validated as they have for adults.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6,10</span></a> We have presented this case because it provides an example of a false positive for subungual melanoma. We do, however, strongly recommend performing biopsy whenever the Hutchinson sign is observed due to its close association with subungual melanoma.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of Interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Case Description" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Discussion" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of Interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Catalán V, Yagnam M, Morales C, Villagra M. ¿Es el signo de Hutchinson patognomónico de melanoma subungueal. Actas Dermosifiliogr. 2018;109:573–575.</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" => 675 "Ancho" => 900 "Tamanyo" => 108438 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical appearance: longitudinal melanonychia with periungual pigmentation (Hutchinson sign).</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" => 835 "Ancho" => 900 "Tamanyo" => 42790 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Dermoscopy findings: regular, parallel bands, brown pigmentation of proximal and lateral nail folds (Hutchinson sign).</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" => 675 "Ancho" => 900 "Tamanyo" => 113859 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Acanthotic squamous epithelium with adequate cell maturation, epithelial melanosis in the basal layer, and isolated melanophages in the stroma. Note the absence of melanocytic proliferation (hematoxylin-eosin, original magnification ×<span class="elsevierStyleHsp" style=""></span>400).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Subungual melanoma: A deceptive disorder" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "G.A. 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año/Mes | Html | Total | |
---|---|---|---|
2024 Noviembre | 178 | 10 | 188 |
2024 Octubre | 1266 | 61 | 1327 |
2024 Septiembre | 1144 | 65 | 1209 |
2024 Agosto | 1117 | 85 | 1202 |
2024 Julio | 1190 | 88 | 1278 |
2024 Junio | 756 | 63 | 819 |
2024 Mayo | 680 | 59 | 739 |
2024 Abril | 649 | 56 | 705 |
2024 Marzo | 788 | 44 | 832 |
2024 Febrero | 830 | 44 | 874 |
2024 Enero | 1172 | 48 | 1220 |
2023 Diciembre | 1018 | 27 | 1045 |
2023 Noviembre | 928 | 52 | 980 |
2023 Octubre | 1025 | 46 | 1071 |
2023 Septiembre | 936 | 40 | 976 |
2023 Agosto | 609 | 31 | 640 |
2023 Julio | 451 | 43 | 494 |
2023 Junio | 521 | 31 | 552 |
2023 Mayo | 692 | 38 | 730 |
2023 Abril | 575 | 28 | 603 |
2023 Marzo | 456 | 40 | 496 |
2023 Febrero | 410 | 25 | 435 |
2023 Enero | 425 | 24 | 449 |
2022 Diciembre | 325 | 54 | 379 |
2022 Noviembre | 318 | 23 | 341 |
2022 Octubre | 298 | 27 | 325 |
2022 Septiembre | 337 | 46 | 383 |
2022 Agosto | 302 | 54 | 356 |
2022 Julio | 267 | 45 | 312 |
2022 Junio | 251 | 30 | 281 |
2022 Mayo | 819 | 51 | 870 |
2022 Abril | 993 | 58 | 1051 |
2022 Marzo | 1153 | 64 | 1217 |
2022 Febrero | 739 | 31 | 770 |
2022 Enero | 953 | 48 | 1001 |
2021 Diciembre | 818 | 58 | 876 |
2021 Noviembre | 805 | 65 | 870 |
2021 Octubre | 1091 | 97 | 1188 |
2021 Septiembre | 910 | 57 | 967 |
2021 Agosto | 1224 | 66 | 1290 |
2021 Julio | 1274 | 42 | 1316 |
2021 Junio | 1343 | 53 | 1396 |
2021 Mayo | 1404 | 77 | 1481 |
2021 Abril | 2466 | 106 | 2572 |
2021 Marzo | 1610 | 51 | 1661 |
2021 Febrero | 1202 | 43 | 1245 |
2021 Enero | 1186 | 39 | 1225 |
2020 Diciembre | 1154 | 38 | 1192 |
2020 Noviembre | 1115 | 24 | 1139 |
2020 Octubre | 824 | 25 | 849 |
2020 Septiembre | 861 | 33 | 894 |
2020 Agosto | 552 | 22 | 574 |
2020 Julio | 368 | 22 | 390 |
2020 Junio | 180 | 30 | 210 |
2020 Mayo | 96 | 27 | 123 |
2020 Abril | 40 | 17 | 57 |
2020 Marzo | 10 | 10 | 20 |
2020 Febrero | 1 | 0 | 1 |
2019 Mayo | 0 | 1 | 1 |