Pigmented lesions of the nail bed - Clinical assessment and biopsy.

BACKGROUND: Subungual melanoma is an uncommon type of melanoma that can be difficult to diagnose. Patients often present with advanced primary lesions and have an associated increased risk of nodal disease. Delays in diagnosis are believed to contribute to poor patient outcomes. OBJECTIVE: The objective of this article is to offer an approach to assessing and managing patients who present with subungual pigmented lesions. We describe the anatomy of the nail bed to offer a rationale for our technique of nail bed biopsy, and warn of the potential to cause permanent nail dystrophy through other approaches. DISCUSSION: Many clinicians have limited experience in assessing lesions of the nail apparatus.Subungual pigmentation has extremely broad differential diagnoses, which include a variety of benign pathologies. A systematic approach to assessment, and early referral of patients with suspicious lesions to a specialist unit, has the potential to improve patient outcomes.

Bilateral scaphotrapezium-trapezoid coalition with bipartite scaphoid: case report.

We report on a 15-year-old girl with bilateral scaphotrapezium-trapezoid coalitions and bipartite scaphoids. There was no history of trauma or any other associated pathology. Wrist pain was alleviated by arthrodesis of the pseudarthrosis of the scaphoid component of the coalitions. Coalition of the distal portions of the scaphoids may have interfered with union of 2 ossification centers of the scaphoid. It is also possible that the carpal coalitions predisposed the scaphoid to fracture and that this represents bilateral nonunion.