Nail pigmentation beginners level by L Thomas

hello this first podcast is dedicated to the management of the longitudinal pigmentation of the neural unit also known as mallanna Nikias together in this first part we will speak about the general context of the disease and the clinical features as shown in this large study about a cruel antigen is melanoma it is very common that the diagnosis of melanoma of the nail unit is delayed by many days weeks months or years in our patients and in this work we could demonstrate that all our patient had received at least one line of antifungal treatment for their pigmentation of the nail unit but it also it is also known that in most cases melanoma of the nail unit starts as a Lunger longitudinal nail pigmentation also known as mallanna nakiya's together and this is not a new finding almost two centuries ago the first description of melanin akia strata showed that the lesion starts 20 years earlier in this patient as a black line in Lenoir in French it is of course very important to make an early diagnosis to reduce mortality and morbidity due to advanced melanoma but it is also very important to propose an early diagnosis of this chima to avoid unnecessary surgery to avoid amputation and to avoid disability for that reason is it is very important to recognize and to make an appropriate diagnosis of melanin aqui estoy Yetta but unfortunately it is a syndrome with multiple causes longitudinal nail pigmentation also known as mallanna Nakia strata may correspond to a melanocytic nevus a benign lesion but also to melanoma a malignant neoplasm but unfortunately longitudinal pigmentation is also observed in ethnic type pigmentation usually in skin type 5 & 6 patients it usually involves many nails it is also observed in subungual hemorrhages it is observed in lanta genesis of the nail unit like Lucy itsuka disease but in that case the pigmentation is often observed on other nails and it is also observed on the mucous membranes drug-induced pigmentation is a very common disease it is caused by many drugs like and ty AIDS drugs like anti to be Colossus drugs and like sit aesthetic chemotherapies onychomycosis is not frequently pigmented but it could be pigmented in some cases trauma-induced pigmentation is a very common disorder on the fifth toe of course but also and the first one when the second one is passion pushing on the nail plate Bowens disease can be pigmented in some rare cases and on Ikoma trachoma which is a very rare nail neoplasm a benign condition is in some cases pigmented also but if you want to know what is really going on to explain this nail pigmentation you have to look at the nail matrix and to look at the nail matrix you need to perform a very aggressive surgery this one exposing the neon matrix after removal of the nail plates to look what is going on underneath and to take a biopsy taking such a biopsy can vine and give very ugly scars like this one this one or even this one when complete excision of the nail unit is necessary for that reason some clinician F develop a clinical algorithm to make the difference between benign and malignant Melanie Kia's toyota in favor of a benign type are the following features when the lesion is acquired during childhood when its present on multiple fingers or toes we say it's poly dactylic when it's stable over time when there is another good explanation for the pigmentation for example a drug intake or a knitting group that is often pigmented and when there is no Perry angle involvement on the other end the onset during adulthood when the lesion is only on one finger or one toe when it's changing over time when there is some pigmentation of the penguin skin that is also known as itching sunshine when the multiple colors are observed when the lesion is triangular-shaped when there are some changes especially erosion of the nail plates all these signs are in favor of a malignant melanoma kia's together childhood onset like in this two days old boy is benign when it's polydactyly or when like in this patient it's due to its is ethnic type its rather benign on the other end when the lesion has multiple colors when there is some pigmentation of the pairing water quick skin also known as a chinks ensign and when there is when there are changes of the nail plate like this erosion it's in favor of a malignant manicures to enter when it's changing over time when the lesion is triangular shaped then it's again in favor of a malignant melanoma estrada I come to my conclusion for this podcast early recognition of the nail unit melanoma permits to offer a treatment with the higher chances of success it also permits to reduce the disability due to surgery when a conservative treatment is possible in most cases melanoma of the nail unit begins as a longitudinal nail pigmentation along the nail plates also known as Milan Monica's Toyota however Melanie castrato is a syndrome with multiple causes included of course melanoma but also benign conditions knowing the commonest clinical features of a malignant melanoma Asturia that permits to better select the cases that must be submitted to a biopsy and in the next podcast dedicated to nail pigmentation we will see how the MAS copy offers additional informations to improve the management of these difficult cases so this is to be continued I thank my co-workers and I thank you all for listening goodbye you

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