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HealthCert Education > Nail lesions > Flashcards

Nail lesions Flashcards

1
Q

Longitudinal nail pigmentation - AKA ….

A

melanonychia striata longitudinalis

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2
Q

melanonychia striata longitudinalis definition

A

pigmentation along nail plate in band-like fashion

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3
Q

melanonychia striata longitudinalis is symmetrical because …

A

pigmentation of nail matrix produced pigmentation along nail plate with band like fashion - the lesion is symmetrical because of growth of the nail plate

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4
Q

Does symmetrical lesion r/o melanoma

A

No

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5
Q

Importance of early diagnosis on fingers and toes -

A

Can offer conservative treatment

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6
Q

melanonychia striata longitudinalis benign causes

A 
ethnic type pigmentation
subungual hemorrhage 
letiginosis - Laugier Hutziker disease
drug induced - AZT + anti-TB drugs
onychomycosis - very rare cause 
trauma induced pigmentation - common 
melanocytic nevus
onychomatricoma
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7
Q

melanonychia striata longitudinalis malignant causes

A

SCC in situ - Bowen’s disease

Melanoma

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8
Q

subungual hemorrhage confusing patterns -

A

some cases may have band like pattern

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9
Q

onychomycosis rare pattern

A

band like pigmentation

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10
Q

when should fungal infection be considered as cause of pigmentation?

A

When all other causes excluded

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11
Q

trauma induced pigmentation - cause -

A

due to friction 2nd toe over first one

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12
Q

trauma induced pigmentation - common sites -

A

external aspect big toe

intimal aspect big toe

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13
Q

bowen’s disease - relationship of pigmentation to skin type

A

on skin pigmentation usually observed in dark skin

on nail pigmentation can occur in light skinned individuals

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14
Q

is Bowen’s disease on nail common?

A

no, it is very rare.

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15
Q

onychomatricoma - what is it?

A

Rare tumour
Specific to nail unit
Dt proliferation of nail matrix.

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16
Q

onychomatricoma - how does it enter into differential

A

May produce pigmented band on nail unit

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17
Q

melanonychia striata longitudinalis - problems with surgery

A

very painful

will likely disfigure the nail and may lead to functional problems with the digit

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18
Q

Clinical algorithm for avoiding biopsy

A

Acquired during childhood
Polydactlylic
Stable
Another good explanation - drug, ethnicity etc

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19
Q

Clinical algorithm for avoiding biopsy

A 
Acquired during childhood
Polydactlylic
Stable
Another good explanation - drug, ethnicity etc
No periungual inolvement.
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20
Q

Melanoma of nail is most common melanoma in ….

A

black people who also have ethnic pigmentation

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21
Q

Clinical algorithm in favour of biopsy

A

Acquired during adulthood
Monodactylic
Changes over time - long period of observation
Peri-ungual involvement. (Hutchinson’s sign)
Polychromia
Triangular shaped

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22
Q

Clinical algorithm in favour of biopsy

A

Acquired during adulthood
Monodactylic
Changes over time - long period of observation
Peri-ungual involvement. (Hutchinson’s sign)
Polychromia
Triangular shaped (adult)
Changes of plate - erosion/ longitudinal groove

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23
Q

Triangular shape in adult means …

A

lesion is enlarging faster than nail is growing

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24
Q

Hairpin vessels surrounded by white tissue in favour of …

A

keratinizing tumour in nail unit

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25
Q

Atypical vessels, linear irregular, milky red areas, multiple types of vessels in favour of …

A

suggestive of melanoma

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26
Q

Remnant of pigmentation on Dermoscopy in favour of …

A

malignancy, likely melanoma

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27
Q

Blood spots, due to …

A

hemorrhage under nail plate

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28
Q

Blood spots, colour

A

not specific - purple or red, recent

black or brown, older

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29
Q

Blood spot, shape

A

Proximal rounded

Distal filamentous

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30
Q

Blood spots are observed in ……. % of melanomas of nail unit.

A

60%

31
Q

Blood spots are observed in ……. % of SCC of nail unit.

A

25%

32
Q

Blood spots - management

A

ensure lesion resolves over time. 4 + 12 months

33
Q

Background pigment

A

Brown - significant melanocytic hyperplasia.

Grey or yellowish - increased contact of melanin in keratinocytes

34
Q

Melanocytic lesions - colour is largely related to …

A

skin type

35
Q

Brown longitudinal lines - benign

A

brown background, lines are regular in colour, spacing, and thickness

36
Q

Brown longitudinal lines - melanoma

A

irregular colour, spacing, thickness

rarely parallelism disruption

37
Q

Greyish or grey yellowish background pigment

A 
Ungual Lentigo
Ethnic pigmentation (darker skin)
Laugier Hunziker
Drug induced
Repetitive trauma (darker skin)
38
Q

Micro-hutchinson’s sign. (Rare)

A

Pigmentation of peri-ungual skin only observed with Dermoscopy.

39
Q

Micro-hutchinson’s sign, significance…

A

Usually melanoma

40
Q

Longitudinal whitish/ yellowish pigmentation is known as …

A

Longitudinal leuco/xanthonychia.

41
Q

Longitudinal whitish/ yellowish pigmentation is known as …

A

Longitudinal leuco/xanthonychia.

42
Q

Yellowish pigmentation is significant when ….

A

associated with distal subungal hyperkeratosis

43
Q

Yellowish pigmentation is significant when ….

A

associated with distal subungal hyperkeratosis

44
Q

Yellowish pigmentation associated with distal subungal hyperkeratosis suggests that …

A

there is a keratinizing tumour in nail matrix.

45
Q

Yellowish pigmentation associated with distal subungal hyperkeratosis may also be associated with …

A

erosion of distal nail plate or longitudinal grooves in the nail plate

46
Q

distal subungal hyperkeratosis is observed by …

A

examination of the distal nail unit by Dermoscopy

47
Q

splinter hemorrhages are common finding in ….

A

nail unit tumours

48
Q

Longitudinal leuco/xanthonychia is observed in % SCC

A

60%

49
Q

Longitudinal leuco/xanthonychia is observed in % Onychomatricoma

A

53%

50
Q

Longitudinal leuco/xanthonychia is observed in which other lesions?

A

Hemangioma 30%

Glomus cell tumour 30%

51
Q

subungal distal hyperkeratosis is observed in % SCC

A

73%

52
Q

subungal distal hyperkeratosis is observed in % Onychomatricoma

A

70%

53
Q

Linear micro-hemorrhages are common in …

A

any type of malignant tumour

54
Q

Linear micro-hemorrhages in tumours manifest as …

A

linear hemorrhages in band-like fashion

55
Q

Linear micro-hemorrhages without pigmentation good sign of …

A

keratinizing tumour

56
Q

Linear micro-hemorrhages occurs in what type of melanoma?

A

Advanced melanoma

57
Q

Linear micro-hemorrhages observed in % onychomatricoma

A

67%

58
Q

Linear micro-hemorrhages observed in % SCC

A

35%

59
Q

Linear micro-hemorrhages observed in % Achromic malignant melanoma

A

40%

60
Q

Pigmented melanoma Dermoscopy features: Common

A 
Brown background (95%)
Irregular pattern of lines (95%)
61
Q

Pigmented melanoma Dermoscopy features: Uncommon

A

Micro Hutchinson’s sign 15%

Splinter hemorrhages 5% (advanced cases)

62
Q

Nail-matrix melanocytic nevus dermoscopic patterns

A

Brown background 100%

Regular pattern of lines 94%

63
Q

Subungual hemorrhage dermoscopic patterns

A

Blood spot 100%

  • No other sign
  • Clearance of lesion 3-6 months
64
Q

When looking at subungual hemorrhage always ….

A

use the Dermoscope

65
Q

Nail unit lentigo and lentiginosis

A

Grey lines 93%

No other change of nail plate

66
Q

Grey lines 93%, No other change of nail plate also found in ….

A

Drug induced pigmentation
Chronic trauma inducted pigmentation
Ethnic type pigmentation

67
Q

Pigmented Bowen’s disease uncommon Dermoscopy features

A

Subungual distal hyperkeratosis 70%
Longitudinal leuco-xanthonychia 60%
Polychromia (grey, white, yellow, red) 45%
Triangular distal onycholysis, convex deformity and yellow spot 40%
Linear microhemorrhages (35%)

68
Q

Onychomatricoma

A 
Subungual hyperkeratosis (73%)
Linear microhemorrhages (67%)
Convex deformity of the nail plate, longitudinal leucoxanthonychia (53%)
Triangular distal onycholysis
69
Q

Follow u p with doubtful lesions

A

4,8,12,18 months

70
Q

Probably with too early surgery -

A

very early melanoma shows few atypical melanocytes - can confuse pathologist.

71
Q

Clinical management algorithm

A

Atypical > Surgical biopsy

Non atypical > 4 month control > no modification> annual follow up.

72
Q

Dermoscopy nail bed and matrix - non melanocytic

A

homogenous pigmentation - brown or grey

73
Q

Dermoscopy nail bed and matrix - melanocytic

A

bands

74
Q

Dermoscopy nail bed and matrix - benign patterns

A

Non melanocytic
Lines regular
Lines regular + regular globules

HealthCert Education (24 decks)

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