Naslov
Diagnostic challenge of early subungual melanoma

Autori
Delaš Aždajić, Marija ; Lovrić, Ivana ; Franceschi Nika ; Šitum, Mirna ; Vučić, Majda ; Buljan, Marija

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, ostalo

Skup
3. Konferencija o palijativnoj skrbi s međunarodnim sudjelovanjem: “Palijativna skrb u zajednici – hrvatska i europska iskustva“

Mjesto i datum
Pula, Hrvatska, 04.10.2018. - 07.10.2018

Vrsta sudjelovanja
Poster

Vrsta recenzije
Domaća recenzija

Ključne riječi
subungual melanoma ; histologic type ; Hutchinson sign ; nails ; diagnosis
(subungual melanoma ; histologic type ; nails ; Hutchinson sign ; diagnosis)

Sažetak
Introduction The early stage of subungual melanoma is often difficult to differentiate from benign melanocytic lesions. As treatment and prognosis of the two entities significantly differ, correct diagnosis is essential. Subungual melanoma initially presents as melanonychia striata, followed by Hutchinson sign, which is considered to be the most significant clinical sign for differentiating subungual melanoma and benign melanocytic lesions. Case report A 57-year-old female presented with a 3- year history of a pigmented longitudinal streak of the left index fingernail (Figure 1a) There were no signs of nail destruction, and she did not recall any trauma to the finger. Dermoscopic examination showed unevenly pigmented longitudinal lines in the entire nail plate with pigmentation extending to the distal nail fold (Hutchinson sign, Figure 1c). A nail matrix biopsy was performed and histopathological analysis revealed only focal hyperpigmented epithelial basal layer without cell atypia. Due to the progression of periungual pigmentation, a skin biopsy was performed a month later, again with no histological confirmation of melanocytes. During regular follow-up, progression of atypical pigmentation was observed, as well as partial nail dystrophy. Therefore, nail matrix biopsy was repeated, showing only focal hyperpigmented basal cells with evenly distributed multiplied melanocytes without nest formation, which was in accordance with the diagnosis of lentigo. During the following months, the discoloration and nail dystrophy with subungual hyperkeratosis further progressed (Figure 1d). Total avulsion of the nail unit with Blair skin- graft was performed and histopathological analysis showed atypical melanocytes, irregularly distributed without nest formation, which confirmed the diagnosis of acral lentiginous melanoma in situ (Figure 1b). Conclusion Occasionally histological findings do not correspond with clinical diagnosis. It is important to focus on clinical signs because clinical judgement and continuous follow-up of the patient with properly performed diagnostic procedures lead to the correct diagnosis. In early lesions of in situ melanoma, atypia is often focal and moderate, as is the pagetoid spread, which represents a challenge in diagnosing early acral lentiginous melanoma. At times, only invasive procedures, such as total nail avulsion, enable correct diagnosis confirmation.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

POVEZANOST RADA