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• W4364355611 abstract "Longitudinal melanonychia (LM) is a common dermatologic examination finding, with various benign and malignant underlying etiologies. Biopsy analysis for histopathologic examination is the diagnostic standard. Biopsy overuse can lead to negative effects, including permanent nail dystrophy. However, underuse of biopsy leads to risk of delayed diagnosis of melanomas and poor outcomes. We conducted a single-center, retrospective review of the electronic medical and pathology records for patients aged >18 years with the clinical finding of LM who underwent nail biopsy between January 2000 and August 2022. We evaluated the characteristics of LM from different etiologies and calculated the number needed to biopsy (NNB) as 1/p, with p representing the number of malignancies biopsied divided by total number of biopsies.1Nault A. Zhang C. Kim K. Saha S. Bennett D.D. Xu Y.G. Biopsy use in skin cancer diagnosis: comparing dermatology physicians and advanced practice professionals.JAMA Dermatol. 2015; 151: 899-902https://doi.org/10.1001/jamadermatol.2015.0173Crossref PubMed Scopus (44) Google Scholar,2Privalle A. Havighurst T. Kim K. Bennett D.D. Xu Y.G. The number of skin biopsies needed per malignancy: comparing the use of skin biopsies among dermatologists and non-nondermatologist clinicians.J Am Acad Dermatol. 2020; 82: 110-116https://doi.org/10.1016/j.jaad.2019.08.012Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar One hundred and sixty-three nail biopsies of LM were performed, of which 73% of patients were White, 18% were Hispanic/Latino, and 10% were Black. Twenty-two percent (n = 34) were malignant, including 22 malignant melanoma, 11 melanoma in situ, and 1 squamous cell carcinoma. NNB for this population was 4.94. The remaining 129 noncancerous diagnoses included subungual hemorrhage (n = 67), lentigo (n = 18), benign nevi (n = 2), myxoid cyst (n = 5) subungual exostosis (n = 2), onychopapilloma (n = 1), and onychomatricoma (n = 1). There were no significant differences in sex, race, ethnicity, or digit involved when comparing benign versus malignant biopsy results. Mean age at biopsy was 55 (range, 18-92) years with no significant difference between benign versus malignant diagnosis groups. Melanoma prevalence did not significantly differ by age group. The most commonly affected digits were the left thumb and bilateral first toes, in the benign and malignant LM groups (Table I). Most nail biopsies were performed by dermatologists and hand surgeons (n = 134).Table IClinical characteristics by malignancy statusClinical CharacteristicsTotalBenignMalignantP valueSex Female907317.5625 Male735617Mean Age at Biopsy555558.2994Age (ys) 18-3017125.4502 31-4018162 41-5024213 51-6034295 61-70413011 >7029227Location Left first toenail25205>.9999 Right first toenail26206.7937 Left thumb fingernail24168.1103 Right thumb fingernail18144>.9999 Left second toenail440.5807 Right second toenail440.5807 Left index fingernail770.3466 Right index fingernail1091.6894 Left third toenail440.5807 Right third toenail550.5847 Left long fingernail642.6057 Right long fingernail642.6057 Left fourth toenail110>.9999 Right fourth toenail541>.9999 Left ring fingernail431>.9999 Right ring fingernail211.3747 Left fifth toenail431>.9999 Right fifth toenail220>.9999 Left small fingernail321.5067 Right small fingernail422.1923Race White1077829.0788 Black14131.1899 Asian651>.9999Ethnicity Hispanic18153.7655 Open table in a new tab In this single-center cohort of 163 adult patients, nearly one-quarter of nail biopsies performed due to LM were found to be malignant, resulting in an NNB of <5. There is a wide range of NNB for nail apparatus melanoma (NAM) as determined by publicly available data (Table II).1Nault A. Zhang C. Kim K. Saha S. Bennett D.D. Xu Y.G. Biopsy use in skin cancer diagnosis: comparing dermatology physicians and advanced practice professionals.JAMA Dermatol. 2015; 151: 899-902https://doi.org/10.1001/jamadermatol.2015.0173Crossref PubMed Scopus (44) Google Scholar, 2Privalle A. Havighurst T. Kim K. Bennett D.D. Xu Y.G. The number of skin biopsies needed per malignancy: comparing the use of skin biopsies among dermatologists and non-nondermatologist clinicians.J Am Acad Dermatol. 2020; 82: 110-116https://doi.org/10.1016/j.jaad.2019.08.012Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar, 3Ronger S. Touzet S. Ligeron C. et al.Dermoscopic examination of nail pigmentation.Arch Dermatol. 2002; 138: 1327-1333https://doi.org/10.1001/archderm.138.10.1327Crossref PubMed Scopus (249) Google Scholar, 4Ko D. Oromendia C. Scher R. Lipner S.R. A retrospective single-center study evaluating the clinical and dermoscopic features of longitudinal melanonychia, ABCDEF criteria, and risk of malignancy.J Am Acad Dermatol. 2019; 80: 1272-1283https://doi.org/10.1016/j.jaad.2018.08.033Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar, 5Lohman M.E. McCalmont T.H. Cordoro K.M. An evidence-based approach to pediatric melanonychia.Dermatol Clin. 2022; 40: 37-49https://doi.org/10.1016/j.det.2021.09.004Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar In addition, our results are in contrast to a recent review on pediatric LM, a difference that is likely due to age (pediatric vs adult patients).5Lohman M.E. McCalmont T.H. Cordoro K.M. An evidence-based approach to pediatric melanonychia.Dermatol Clin. 2022; 40: 37-49https://doi.org/10.1016/j.det.2021.09.004Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar The NNB for NAM (range, 4.94-10.50) is much lower than NNB for cutaneous melanoma (range, 14.33-53.56).1Nault A. Zhang C. Kim K. Saha S. Bennett D.D. Xu Y.G. Biopsy use in skin cancer diagnosis: comparing dermatology physicians and advanced practice professionals.JAMA Dermatol. 2015; 151: 899-902https://doi.org/10.1001/jamadermatol.2015.0173Crossref PubMed Scopus (44) Google Scholar, 2Privalle A. Havighurst T. Kim K. Bennett D.D. Xu Y.G. The number of skin biopsies needed per malignancy: comparing the use of skin biopsies among dermatologists and non-nondermatologist clinicians.J Am Acad Dermatol. 2020; 82: 110-116https://doi.org/10.1016/j.jaad.2019.08.012Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar, 3Ronger S. Touzet S. Ligeron C. et al.Dermoscopic examination of nail pigmentation.Arch Dermatol. 2002; 138: 1327-1333https://doi.org/10.1001/archderm.138.10.1327Crossref PubMed Scopus (249) Google Scholar, 4Ko D. Oromendia C. Scher R. Lipner S.R. A retrospective single-center study evaluating the clinical and dermoscopic features of longitudinal melanonychia, ABCDEF criteria, and risk of malignancy.J Am Acad Dermatol. 2019; 80: 1272-1283https://doi.org/10.1016/j.jaad.2018.08.033Abstract Full Text Full Text PDF PubMed Scopus (23) Google ScholarTable IIThe number needed to biopsyStudyNail associatedMelanoma (n)Total Biopsied (n)NNBNault et al 20151Nault A. Zhang C. Kim K. Saha S. Bennett D.D. Xu Y.G. Biopsy use in skin cancer diagnosis: comparing dermatology physicians and advanced practice professionals.JAMA Dermatol. 2015; 151: 899-902https://doi.org/10.1001/jamadermatol.2015.0173Crossref PubMed Scopus (44) Google Scholarno2349221.39Privalle et al 20202Privalle A. Havighurst T. Kim K. Bennett D.D. Xu Y.G. The number of skin biopsies needed per malignancy: comparing the use of skin biopsies among dermatologists and non-nondermatologist clinicians.J Am Acad Dermatol. 2020; 82: 110-116https://doi.org/10.1016/j.jaad.2019.08.012Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholarno79151719.20Bender et al 2023yes331634.94Ronger et al 20023Ronger S. Touzet S. Ligeron C. et al.Dermoscopic examination of nail pigmentation.Arch Dermatol. 2002; 138: 1327-1333https://doi.org/10.1001/archderm.138.10.1327Crossref PubMed Scopus (249) Google Scholaryes201487.40Ko et al 20194Ko D. Oromendia C. Scher R. Lipner S.R. A retrospective single-center study evaluating the clinical and dermoscopic features of longitudinal melanonychia, ABCDEF criteria, and risk of malignancy.J Am Acad Dermatol. 2019; 80: 1272-1283https://doi.org/10.1016/j.jaad.2018.08.033Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholaryes88410.50Lohman et al 20225Lohman M.E. McCalmont T.H. Cordoro K.M. An evidence-based approach to pediatric melanonychia.Dermatol Clin. 2022; 40: 37-49https://doi.org/10.1016/j.det.2021.09.004Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar∗Pediatric cases only.yes2208104.00NNB, Number needed to biopsy.∗ Pediatric cases only. Open table in a new tab NNB, Number needed to biopsy. It is important to distinguish benign cases of LM from NAM. Previous studies have proposed the use of an ABCEDF rule for NAM, with A representing both age (peak incidence, fifth-seventh decades) and African Americans, Asians, and Native Americans (NAM accounts for 1/3 of melanomas in these groups).4Ko D. Oromendia C. Scher R. Lipner S.R. A retrospective single-center study evaluating the clinical and dermoscopic features of longitudinal melanonychia, ABCDEF criteria, and risk of malignancy.J Am Acad Dermatol. 2019; 80: 1272-1283https://doi.org/10.1016/j.jaad.2018.08.033Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar B stands for Brown to Black, breadth ≥ 3 mm, and irregular borders. C stands for change in appearance and/or lack of change despite treatment. D stands for the digit most commonly involved (thumb > hallux). E stands for extension (Hutchinson sign) and F stands for family (or personal) history of melanoma.4Ko D. Oromendia C. Scher R. Lipner S.R. A retrospective single-center study evaluating the clinical and dermoscopic features of longitudinal melanonychia, ABCDEF criteria, and risk of malignancy.J Am Acad Dermatol. 2019; 80: 1272-1283https://doi.org/10.1016/j.jaad.2018.08.033Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar However, recent studies have reported no significant differences between benign LM and NAM with regards to ABCDEF.4Ko D. Oromendia C. Scher R. Lipner S.R. A retrospective single-center study evaluating the clinical and dermoscopic features of longitudinal melanonychia, ABCDEF criteria, and risk of malignancy.J Am Acad Dermatol. 2019; 80: 1272-1283https://doi.org/10.1016/j.jaad.2018.08.033Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar The findings of the current study suggest that, using good clinical judgment (eg, ruling out fungus and hematoma), all concerning adult LM should undergo biopsy analysis to rule out NAM. None disclosed." @default.
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• W4364355611 title "Number needed to biopsy for longitudinal melanonychia: A retrospective review" @default.
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