Key clinical features in individuals with darker skin tones
• In patients with darker skin tones, LM tends to occur on multiple nails as a result of melanocytic activation.2,13
• Several longitudinal bands may be noted on the same nail and the pigmentation of the bands may vary. With age, these longitudinal bands typically increase in number and width.13
• Pseudo-Hutchinson sign may be present due to ethnic melanosis of the proximal nail fold.13,14
• Dermoscopic findings of LM in patients with skin of color include wider bands (P = .0125), lower band brightness (P < .032), and higher frequency of changing appearance of bands (P = .0071).15
Worth noting
When patients present with LM, thorough examination of the nail plate, periungual skin, and distal pulp of all digits on all extremities with adequate lighting is important.2 Dermoscopy is useful, and a gel interface helps for examining the nail plates.7
Clinicians should be encouraged to biopsy or immediately refer patients with concerning nail unit lesions. Cases of LM most likely are benign, but if some doubt exists, the lesions should be biopsied or tracked closely with clinical and dermoscopic images, with a biopsy if changes occur.16 In conjunction with evaluation by a qualified clinician, patients also should be encouraged to take photographs, as the evolution of nail changes is a critical part of clinical decision-making on the need for a biopsy or referral.
Health disparity highlight
Despite the disproportionately high mortality rates from subungual melanoma in Black and Hispanic populations,3,9 studies often do not adequately represent these populations. Although subungual melanoma is rare, a delay in the diagnosis contributes to high morbidity and mortality rates.