Nailing the diagnosis in pigmented patterns

Longitudinal changes in a single nail segment may be a sign of melanoma

Melanomas of the nail matrix are concealed beneath the proximal nail fold and the proximal part of the nail plate.

nail pigment pattern

They originate from the nail matrix at this location, which extends distally to the level of the lunula.

Fortunately, if a melanoma of the nail matrix is pigmented, the pigment in the stratum corneum of the matrix will be incorporated into the growing nail plate, as it is derived from the structure, and will appear as a longitudinal stripe; longitudinal melanonychia.

Hutchinson’s sign,