Please login or create an account. If you do not have access to this content, you will be shown a 30 second preview and licensing options.

Presentation

Clinical Features and Natural Course of Longitudinal Melanonychia in Children

Description

This study reviewed the clinical features and natural course of longitudinal melanonychia in children because it can resemble nail melanoma and often raises concern. In a retrospective single-center analysis of 703 LM lesions in 381 pediatric patients, with a median follow-up of 1.7 years from first visit and 4.1 years from onset, nearly half of the lesions showed no change, and many became lighter or narrower over time. Some lesions did become darker or wider during follow-up, but these changes did not necessarily mean malignant progression and often later stabilized. Hutchinson sign was seen in a small proportion of lesions, and some of those regressed partially or completely. Overall, 5.5% of lesions completely regressed, and no melanoma cases were detected. Regression was more common in single lesions, left-sided lesions, and those with homogeneous coloration. The authors conclude that pediatric longitudinal melanonychia should be interpreted differently from adult cases, and that in selected patients, careful long-term observation without immediate invasive biopsy may be a reasonable approach.

View more

Conclusions

Pediatric longitudinal melanonychia often behaves benignly and should not automatically be interpreted using the same warning signs as adult nail melanoma.
Clinical, dermoscopic, and even histologic features that raise concern in adults are less reliable for distinguishing malignancy in children.
Many pediatric lesions remain stable, and some that darken or widen later stabilize rather than progress malignantly.
A meaningful proportion of pediatric longitudinal melanonychia partially or completely regresses over time, sometimes after an initial worsening.
Complete regression is more likely in single lesions, lesions on the left side, and lesions with homogeneous pigmentation or color lightening.
Because biopsy can be invasive and risk permanent nail deformity, long-term observation can be a reasonable management strategy in selected children.
In this study, no nail melanoma cases were detected during follow-up, supporting cautious surveillance over immediate invasive intervention in many pediatric cases.

Choi et al. Korean J Dermatol (2016)
Leung et al. Int J Dermatol (2007)
Duhard et al. Ann Dermatol Venereol (1995)
Clinical and histopathologic features of pediatric longitudinal melanonychia: A multicenter retrospective study#10.1016/j.jaad.2023.02.019
Lee et al. J Am Acad Dermatol (2023)