A Call for Nail Clipping Histopathology to Become an Essential Component of the Routine Evaluation of Melanonychia

Abstract

The diagnosis and management of longitudinal melanonychia are challenging for both dermatologists and dermatopathologists, as nail unit melanoma (NUM) is often a consideration. Definitive diagnosis often requires nail matrix sampling, however, this may be difficult to obtain for a variety of reasons. Nail clipping histopathology can provide extensive information in the evaluation of melanonychia with minimal discomfort for a patient, and little disruption to a physician's clinic flow.

Journal of Cutaneous Pathology

A call for nail clipping histopathology to become an essential component of the routine evaluation of melanonychia: benefitting patients as a triage and surgical planning maneuver

J. Cutan. Pathol 2022 Dec 14;[EPub Ahead of Print], O Rodriguez, R Elenitsas, AJ Jiang, J Abbott, AI Rubin 

TAKE-HOME MESSAGE

• Histopathologic evaluation of nail clippings can result in a diagnosis of nail unit melanoma through the identification of melanocyte remnants. Histopathologic examination of nail clippings can also aid in triaging nail unit biopsy and assist in surgical planning. Nail clipping is a painless procedure, and the nail clippings must be at least 4 mm in length for adequate evaluation.
• The authors suggest that dermatologists and dermatopathologists should increase the utilization of nail clipping histopathology in the evaluation of melanonychia to diagnose nail unit melanoma.

–  Kelly B. Scarberry, MD

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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