Histologic distinction between subungual Lentigo and Melanoma

Bijal D. Amin, Kishwer S. Nehal, Achim A. Jungbluth, Bushra Zaidi, Mary S. Brady, Daniel C. Coit, Quin Zhou, Klaus J. Busam

Research output: Contribution to journalArticle

56 Citations (Scopus)

Abstract

The distinction between a benign subungual pigmented macule (lentigo) and an early lesion of melanoma in situ can be difficult. To identify histologic parameters of potential diagnostic value, we retrospectively reviewed biopsies and excisions of 35 pigmented nail lesions. We studied 20 melanomas (10 invasive and 10 noninvasive) and 15 benign subungual melanotic lentigines. Ten specimens of normal nail apparatus obtained for reasons other than melanonychia were also examined as controls. The parameters, which were analyzed, included the density of melanocytes, the presence of multinucleated cells, pagetoid spread, cytologic atypia, inflammation, and the distribution of melanin pigment. The density of melanocytes was measured as the number of cells per 1mm stretch of subungual dermo-epithelial junction [=melanocyte count (MC)]. The MC for invasive melanomas was as follows: mean=102, median=92.5, and range 52 to 212. For noninvasive (only in situ) melanoma, the mean MC was 58.9, median 51, and range 39 to 136. For benign subungual melanotic macules, the mean MC was 15.3, median 14, and range 5 to 31. In normal controls, the mean MC was 7.7, median 7.5, and range 4 to 9. Qualitative features associated with in situ melanoma and useful for its distinction from benign subungual melanotic macules included the presence of confluent stretches of solitary units of melanocytes, multinucleated melanocytes, lichenoid inflammatory reaction, and florid pagetoid spread of melanocytes.

Original languageEnglish (US)
Pages (from-to)835-843
Number of pages9
JournalAmerican Journal of Surgical Pathology
Volume32
Issue number6
DOIs
StatePublished - Jun 2008
Externally publishedYes

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Lentigo
Melanocytes
Melanoma
Nails
Melanins
Cell Count

Keywords

  • Lentigo
  • Melanoma
  • Melanonychia
  • Melanotic macule
  • Subungual

ASJC Scopus subject areas

  • Anatomy
  • Pathology and Forensic Medicine
  • Surgery
  • Medicine(all)

Cite this

Amin, B. D., Nehal, K. S., Jungbluth, A. A., Zaidi, B., Brady, M. S., Coit, D. C., ... Busam, K. J. (2008). Histologic distinction between subungual Lentigo and Melanoma. American Journal of Surgical Pathology, 32(6), 835-843. https://doi.org/10.1097/PAS.0b013e31815c8578

Histologic distinction between subungual Lentigo and Melanoma. / Amin, Bijal D.; Nehal, Kishwer S.; Jungbluth, Achim A.; Zaidi, Bushra; Brady, Mary S.; Coit, Daniel C.; Zhou, Quin; Busam, Klaus J.

In: American Journal of Surgical Pathology, Vol. 32, No. 6, 06.2008, p. 835-843.

Research output: Contribution to journalArticle

Amin, BD, Nehal, KS, Jungbluth, AA, Zaidi, B, Brady, MS, Coit, DC, Zhou, Q & Busam, KJ 2008, 'Histologic distinction between subungual Lentigo and Melanoma', American Journal of Surgical Pathology, vol. 32, no. 6, pp. 835-843. https://doi.org/10.1097/PAS.0b013e31815c8578
Amin, Bijal D. ; Nehal, Kishwer S. ; Jungbluth, Achim A. ; Zaidi, Bushra ; Brady, Mary S. ; Coit, Daniel C. ; Zhou, Quin ; Busam, Klaus J. / Histologic distinction between subungual Lentigo and Melanoma. In: American Journal of Surgical Pathology. 2008 ; Vol. 32, No. 6. pp. 835-843.
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