12/05/14 8:41 AM Melanonychia

Page 1 of 5 http://emedicine.medscape.com/article/1375850-overview
Melanonychia
Author: Chris Adigun, MD; Chief Editor: William D James, MD more...

Updated: May 9, 2013
Background
Melanonychia is brown or black pigmentation of the nail unit. Melanonychia commonly presents as pigmented
band arranged lengthwise along the nail unit, and this presentation is known as longitudinal melanonychia (LM) or
melanonychia striata. The most concerning cause of melanonychia is subungual melanoma, although a variety of
other causes includes physiologic longitudinal melanonychia, systemic disorders, trauma, inflammatory disorders,
fungal infections, drugs, and benign melanocytic hyperplasias.
[1]
See the image below.
Pigmented longitudinal streak secondary to a nail matrix melanoma.
Pathophysiology
Melanonychia most often occurs because of increased production of melanin by melanocytes in the nail matrix. A
healthy adult has approximately 200 melanocytes per mm
2
in the nail matrix, of which the majority remain
dormant. When these melanocytes are activated, melanosomes filled with melanin are transferred to differentiating
matrix cells, which migrate distally as they become nail plate onychocytes.
[2]
This results in a visible band of
pigmentation in the nail plate.
Epidemiology
Frequency
International
Physiologic melanonychia is more common in darker-pigmented individuals. Seventy-seven percent of black
individuals older than 20 years and almost 100% older than 50 years have evidence of this condition.
[3, 4]
LM is
present in 10-20% of Japanese individuals.
[5]
In the general white population, the prevalence of LM is 1.4%.
[6]
Today
News
Reference
Education
Log Out My Account
M Patel
Discussion

12/05/14 8:41 AM Melanonychia
Page 2 of 5 http://emedicine.medscape.com/article/1375850-overview
In a study of 68 Hispanic patients with longitudinal melanonychia, melanonychia secondary to skin pigmentation
was observed in 48 cases (68.6%).
[7]
Of the remaining patients, 6 (8.5%) were secondary to trauma, 5 (7.1%) were
secondary to fungal infection, 4 (5.7%) were associated with benign melanocytic hyperplasia, and 4 (5.7%) had a
nail apparatus malignancy. The remaining 3 (4.3%) cases were of mixed etiology.
The prevalence of affected individuals increases with age.
[6, 8]
Mortality/Morbidity
The morbidity and mortality of melanonychia is dependent on the underlying cause.
Melanonychia secondary to subungual melanoma has the highest morbidity and mortality compared with other
body sites, with reported 5- and 10-year survival rates of 30% and 13%, respectively.
[9]
Race
The frequency of melanonychia varies by the degree of skin pigmentation, as described in Frequency,
International.
Sex
Melanonychia affects males and females equally.
[8]
Age
Typically, melanonychia is more common in older individuals. In children, melanonychia is often caused by
melanocytic nevi. Subungual melanoma or melanoma in situ is very rare in children,
[10, 11]
but has been
reported.
[12]

Contributor Information and Disclosures
Author
Chris Adigun, MD Clinical Assistant Professor of Dermatology, Ronald O Perelman Department of
Dermatology, New York University School of Medicine
Chris Adigun, MD is a member of the following medical societies: American Academy of Dermatology, American
Society for Dermatologic Surgery, and Council for Nail Disorders
Disclosure: Nothing to disclose.
Coauthor(s)
Panta Rouhani, MD, PhD, MPH Resident Physician, Ronald O Perelman Department of Dermatology, New
York University School of Medicine
Panta Rouhani, MD, PhD, MPH is a member of the following medical societies: American Medical Association
and American Public Health Association
Disclosure: Nothing to disclose.
Adam I Rubin, MD Assistant Professor of Dermatology, University of Pennsylvania School of Medicine
Adam I Rubin, MD is a member of the following medical societies: American Academy of Dermatology,
American Medical Association, American Society of Dermatopathology, and Women's Dermatologic Society
Disclosure: Nothing to disclose.
Specialty Editor Board
Richard K Scher, MD Adjunct Professor of Dermatology, University of North Carolina; Professor Emeritus of
Dermatology, Columbia University
Richard K Scher, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy
12/05/14 8:41 AM Melanonychia
Page 3 of 5 http://emedicine.medscape.com/article/1375850-overview
of Dermatology, American College of Physicians, American Dermatological Association, American Medical
Association, Association of Military Surgeons of the US, International Society for Dermatologic Surgery, Noah
Worcester Dermatological Society, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.
David F Butler, MD Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair,
Department of Dermatology, Scott and White Clinic
David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of
Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for
MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa
Disclosure: Nothing to disclose.
Jeffrey Meffert, MD Assistant Clinical Professor of Dermatology, University of Texas School of Medicine at
San Antonio
Jeffrey Meffert, MD is a member of the following medical societies: American Academy of Dermatology,
American Medical Association, Association of Military Dermatologists, and Texas Dermatological Society
Disclosure: Nothing to disclose.
Catherine M Quirk, MD Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania
Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American
Academy of Dermatology
Disclosure: Nothing to disclose.
Chief Editor
William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director,
Department of Dermatology, University of Pennsylvania School of Medicine
William D James, MD is a member of the following medical societies: American Academy of Dermatology and
Society for Investigative Dermatology
Disclosure: Nothing to disclose.
Additional Contributors
Anokhi Jambusaria-Pahlajani, MD Resident Physician, Department of Dermatology, University of
Pennsylvania School of Medicine
Anokhi Jambusaria-Pahlajani, MD is a member of the following medical societies: American Association of
Physicians of Indian Origin and Phi Beta Kappa
Disclosure: Nothing to disclose.
References
1. Jefferson J, Rich P. Melanonychia. Dermatol Res Pract. 2012;2012:952186. [Medline]. [Full Text].
2. Andre J, Lateur N. Pigmented nail disorders. Dermatol Clin. Jul 2006;24(3):329-39. [Medline].
3. Monash S. Pigmentation in the nails of the negro. Arch Dermatol. May 1932;105:6.
4. Leyden JJ, Spott DA, Goldschmidt H. Diffuse and banded melanin pigmentation in nails. Arch Dermatol.
Apr 1972;105(4):548-50. [Medline].
5. Baran R, Kechijian P. Longitudinal melanonychia (melanonychia striata): diagnosis and management. J
Am Acad Dermatol. Dec 1989;21(6):1165-75. [Medline].
6. Duhard E, Calvet C, Mariotte N, Tichet J, Vaillant L. [Prevalence of longitudinal melanonychia in the white
12/05/14 8:41 AM Melanonychia
Page 4 of 5 http://emedicine.medscape.com/article/1375850-overview
6. Duhard E, Calvet C, Mariotte N, Tichet J, Vaillant L. [Prevalence of longitudinal melanonychia in the white
population]. Ann Dermatol Venereol. 1995;122(9):586-90. [Medline].
7. Dominguez-Cherit J, Roldan-Marin R, Pichardo-Velazquez P, et al. Melanonychia, melanocytic
hyperplasia, and nail melanoma in a Hispanic population. J Am Acad Dermatol. Nov 2008;59(5):785-91.
[Medline].
8. Leung AK, Robson WL, Liu EK, et al. Melanonychia striata in Chinese children and adults. Int J Dermatol.
Sep 2007;46(9):920-2. [Medline].
9. Klausner JM, Inbar M, Gutman M, et al. Nail-bed melanoma. J Surg Oncol. Mar 1987;34(3):208-10.
[Medline].
10. Leaute-Labreze C, Bioulac-Sage P, Taieb A. Longitudinal melanonychia in children. A study of eight
cases. Arch Dermatol. Feb 1996;132(2):167-9. [Medline].
11. Goettmann-Bonvallot S, Andre J, Belaich S. Longitudinal melanonychia in children: a clinical and
histopathologic study of 40 cases. J Am Acad Dermatol. Jul 1999;41(1):17-22. [Medline].
12. Iorizzo M, Tosti A, Di Chiacchio N, et al. Nail melanoma in children: differential diagnosis and
management. Dermatol Surg. Jul 2008;34(7):974-8. [Medline].
13. Baran R, Kechijian P. Hutchinson's sign: a reappraisal. J Am Acad Dermatol. Jan 1996;34(1):87-90.
[Medline].
14. Takematsu H, Obata M, Tomita Y, Kato T, Takahashi M, Abe R. Subungual melanoma. A
clinicopathologic study of 16 Japanese cases. Cancer. Jun 1 1985;55(11):2725-31. [Medline].
15. Daniel CR 3rd, Jellinek N.J. Subungual blood is not anways a reassuring sign. J Am Acad Dermatol.
2007;57:176.
16. Levit EK, Kagen MH, Scher RK, Grossman M, Altman E. The ABC rule for clinical detection of subungual
melanoma. J Am Acad Dermatol. Feb 2000;42(2 Pt 1):269-74. [Medline].
17. Braun RP, Baran R, Le Gal FA, et al. Diagnosis and management of nail pigmentations. J Am Acad
Dermatol. May 2007;56(5):835-47. [Medline].
18. Sarti HM, Vega-Memije ME, Dominguez-Cherit J, Arenas R. Longitudinal melanonychia secondary to
chromoblastomycosis due to Fonsecaea pedrosoi. Int J Dermatol. Jul 2008;47(7):764-5. [Medline].
19. Harwood M, Telang GH, Robinson-Bostom L, Jellinek N. Melanoma and squamous cell carcinoma on
different nails of the same hand. J Am Acad Dermatol. Feb 2008;58(2):323-6. [Medline].
20. Ronger S, Touzet S, Ligeron C, et al. Dermoscopic examination of nail pigmentation. Arch Dermatol. Oct
2002;138(10):1327-33. [Medline].
21. Adigun CG, Scher RK. Longitudinal melanonychia: when to biopsy and is dermoscopy helpful?. Dermatol
Ther. 2012;25(6):491-7.
22. Tosti A, Baran R, Piraccini BM, Cameli N, Fanti PA. Nail matrix nevi: a clinical and histopathologic study
of twenty-two patients. J Am Acad Dermatol. May 1996;34(5 Pt 1):765-71. [Medline].
23. Tosti A, Piraccini BM, de Farias DC. Dealing with melanonychia. Semin Cutan Med Surg. Mar
2009;28(1):49-54. [Medline].
24. Collins SC, Cordova K, Jellinek NJ. Alternatives to complete nail plate avulsion. J Am Acad Dermatol. Oct
2008;59(4):619-26. [Medline].
25. Jellinek N. Nail matrix biopsy of longitudinal melanonychia: diagnostic algorithm including the matrix
shave biopsy. J Am Acad Dermatol. May 2007;56(5):803-10. [Medline].
26. Debarbieux S, Hospod V, Depaepe L, Balme B, Poulalhon N, Thomas L. Perioperative confocal
microscopy of the nail matrix in the management of in situ or minimally invasive subungual melanomas. Br
J Dermatol. Oct 2012;167(4):828-36. [Medline].
27. Di Chiacchio N, Loureiro WR, Michalany NS, Kezam Gabriel FV. Tangential Biopsy Thickness versus
12/05/14 8:41 AM Melanonychia
Page 5 of 5 http://emedicine.medscape.com/article/1375850-overview
Lesion Depth in Longitudinal Melanonychia: A Pilot Study. Dermatol Res Pract. 2012;2012:353864.
[Medline]. [Full Text].
28. Collins SC, Jellinek N.J. Matrix biopsy of longitudinal melanonychia and longitudinal Erythronychia: A
step-by-step approach. Cosmetic Derm. 2009;22:130-6.
29. Sureda N, Phan A, Poulalhon N, Balme B, Dalle S, Thomas L. Conservative surgical management of
subungual (matrix derived) melanoma: report of seven cases and literature review. Br J Dermatol. Oct
2011;165(4):852-8. [Medline].
30. Dawber RP, Colver GB. The spectrum of malignant melanoma of the nail apparatus. Semin Dermatol.
Mar 1991;10(1):82-7. [Medline].
31. Massi G, Leboit PE. Nevi on Acral Skin. In: Histological Diagnosis of Nevi and Melanoma. 289. 2004.
32. Amin B, Nehal KS, et al. Histologic distinction between subungual lentigo and melanoma. Am J Surg
Pathol. 32:835-43.
33. Thai KE, Young R, Sinclair RD. Nail apparatus melanoma. Australas J Dermatol. May 2001;42(2):71-81;
quiz 82-3. [Medline].
34. High WA, Quirey RA, Guilln DR, Munz G, Taylor RS. Presentation, histopathologic findings, and clinical
outcomes in 7 cases of melanoma in situ of the nail unit. Arch Dermatol. Sep 2004;140(9):1102-6.
[Medline].
35. Cohen T, Busam KJ, Patel A, Brady MS. Subungual melanoma: management considerations. Am J Surg.
Feb 2008;195(2):244-8. [Medline].
36. Glat PM, Spector JA, Roses DF, Shapiro RA, Harris MN, Beasley RW. The management of pigmented
lesions of the nail bed. Ann Plast Surg. Aug 1996;37(2):125-34. [Medline].
37. Tan KB, Moncrieff M, Thompson JF, et al. Subungual melanoma: a study of 124 cases highlighting
features of early lesions, potential pitfalls in diagnosis, and guidelines for histologic reporting. Am J Surg
Pathol. Dec 2007;31(12):1902-12. [Medline].

Medscape Reference 2011 WebMD, LLC