Carolina Fraga1, Alexandra Azevedo2, Fábio Barroso3 1Pediatrics Department, Centro Materno-Infantil do Norte, Centro Hospitalar Universitário de Santo António, Porto, Portugal, 2Dermatology Department, Centro Hospitalar Universitário de Santo António, Porto, Portugal, 3Pediatrics Department, Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
Address for Correspondence: Carolina Fraga, Largo da Maternidade de Júlio Dinis 45, 4050-651 Porto, Portugal. Email: carolinamoraesfraga@gmail.com
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Discussion :
LM is a dark pigmentation of the nail plate that results from either activation or hyperplasia of melanocytes in the nail matrix. It is more prevalent in darked-skin individuals, mostly in adulthood, being rare in children particularly Caucasian. Familial occurrence with an early age of onset was described only exceptionally. 1
Although it may rarely be secondary to subungual melanoma, it is typically benign in children. Clinical features that raise concern for melanoma include rapid evolution, changing pigmentation or shape, color heterogenicity, blurred lateral borders, pigment band greater than 3 mm and associated nail dystrophy. Hutchinson sign (periungual pigmentation) is a hallmark for subungual melanoma in adults but in children it may be present in benign melanonychia. 2 Most recent publications support a wait-and-see strategy in pediatric LM with clinical and dermoscopic follow-up. Biopsy is indicated in the presence of concerning signs. 1,3| References : | - Leung AKC, Lam JM, Leong KF, Sergi CM. Melanonychia striata: clarifying behind the Black Curtain. A review on clinical evaluation and management of the 21st century. Int J Dermatol. 2019 Nov;58(11):1239-1245. doi: 10.1111/ijd.14464. Epub 2019 Apr 21. PMID: 31006857.
- Cooper C, Arva NC, Lee C, Yélamos O, Obregon R, Sholl LM, Wagner A, Shen L, Guitart J, Gerami P. A clinical, histopathologic, and outcome study of melanonychia striata in childhood. J Am Acad Dermatol. 2015 May;72(5):773-9. doi: 10.1016/j.jaad.2015.01.010. Epub 2015 Mar 9. PMID: 25766363.
- Morato IB, Gontijo JRV, Tavares GT, Bittencourt FV. Longitudinal melanonychia in childhood: a great challenge. An Bras Dermatol. 2022 Jul-Aug;97(4):516-519. doi: 10.1016/j.abd.2021.02.012. Epub 2022 Jun 9. PMID: 35691736; PMCID: PMC9263629.
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Last Shown : Apr 2026
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