BH07 A retrospective review of cases of longitudinal melanonychia referred to a tertiary nail centre over a 5-year period to identify the various subtypes and outcomes
Ali, Christina Moss, Jake
Ali, Christina
Moss, Jake
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Date
2025-06-27
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Abstract
Longitudinal melanonychia (LM) refers to the presence of melanin within the nail plate, presenting as a band or stripe [Haneke E. Melanonychia. In: Scher and Daniel’s Nails: Diagnosis, Surgery, Therapy (Rubin AI, Jellinek NJ, Daniel CR, Scher RK, eds). Cham: Springer International Publishing, 2018; 243–68). It is most prevalent in individuals with darker skin, with almost 100% of older Black people having LM, whereas the incidence in White populations is around 1%. The main causes of LM are either melanocyte activation or proliferation, triggering melanin production. Most types of LM are benign and do not require any specific treatment; however, some can be caused by a nail unit melanoma (NUM). NUM occurs most commonly in adults aged > 40 years, and has an equal incidence between individuals with light or dark skin. A retrospective review was done on all patients referred to a tertiary dermatology nail clinic between 2020 and 2024 to identify cases of LM. Demographic data were collected alongside the investigations and management of LM. In total, 322 patients were referred to the nail clinic between 2020 and 2024, with 54 identified as having LM. The subtypes were determined based on history, dermoscopy and/or biopsy. Overall, 59% (n = 32) of LMs identified were due to melanocyte activation. Frictional LM was most prevalent, followed by trauma then ethnic causes. Thirteen individuals (24%) had melanocyte proliferation, with nail naevus being most common followed by lentigo then NUM. Six cases were due to nonmelanocytic causes and three patients either defaulted from the clinic or are awaiting repeat biopsy, so the cause of LM is unknown. One-half (50%) of patients underwent a nail biopsy, with only one patient, of White ethnicity, proven to have a NUM, which was treated with full nail excision. Most patients were either monitored with photography or given reassurance and discharged. The causes of LM vary from very benign to malignant. A thorough history and examination with dermoscopy and biopsy are essential for diagnosis. Treatment ranges from conservative management to surgical intervention. Our results mirror a study done in 2019 at another dermatology clinic, in which the majority of patients had benign LM, with only one NUM diagnosed on biopsy despite the larger patient population (Jiyad Z, Akhras V. Incidence of melanoma and outcomes of longitudinal melanonychia in a cohort of cases referred to a London dermatology department. Br J Dermatol 2019; 181: 204–5).
Citation
Ali, C., Moss, J., & Takwale, A. (2025). BH07 A retrospective review of cases of longitudinal melanonychia referred to a tertiary nail centre over a 5-year period to identify the various subtypes and outcomes. British Journal of Dermatology, 193(Supplement_1), ljaf085-228.
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