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We call on dermatologists and dermatopathologists to include nail clipping histopathology as an essential component of the routine evaluation of melanonychia. This manuscript demonstrates a case where an adult woman with broad melanonychia of the right thumbnail declined a nail matrix biopsy, but was amenable to a nail clipping. The nail clipping showed pigmentation, melanocyte remnants, and small cavities in the nail plate. These features have been published previously by our group as a clue to nail unit melanoma within nail clippings.This patient was rapidly triaged for nail matrix biopsy, which demonstrated nail unit melanoma in situ. Every patient with melanonychia can benefit from a nail clipping by examination of the location of the pigmentation within the nail plate for surgical planning, and if melanocyte remnants are detected, the nail clipping also serves as a rapid triage mechanism for nail matrix biopsy to evaluate for nail unit melanoma. Fontana-stained sections will highlight the pigmentation in the nail plate, and its location in the nail plate can easily be described by the dermatopathologist. Nail clippings performed in the setting of clinically apparent melanonychia may show helpful histopathologic findings of pigmented fungi, hemorrhage, external pigmentation, features of other pigmented nail unit tumors, as well as other entities. Nail clipping histopathology can provide extensive information in the evaluation of melanonychia with minimal discomfort for a patient, and little disruption to a physician's clinic flow. With this additional case of a nail unit melanoma diagnosed after initial concern found in a nail clipping, as well as other information in the literature, it is clear that melanocyte remnants found in nail clippings are reliable concerning features related to nail unit melanoma in adults. With knowledge of these histopathologic features in nail clippings and the significance of melanocyte remnants, the dermatopathologist can play a crucial role in the use of a nail clipping as a life-saving diagnostic maneuver. Accordingly, given the potential benefit to patients in this setting, as well as other uses of a nail clipping in the evaluation of melanonychia, we call on dermatologists and dermatopathologists to innovate the routine evaluation of melanonychia through the routine employment of nail clippings for histopathologic evaluation. [ABSTRACT FROM AUTHOR]

While our patient, and 90% of patients included in the review, did not recall any specific trauma to the affected site, it is plausible that minor repetitive traumas secondary to footwear or activity[1] could have gone unnoticed. Keywords: acquired ungual; fibrokeratoma; ungual fibrokeratoma EN acquired ungual fibrokeratoma ungual fibrokeratoma 779 782 4 08/16/23 20230901 NES 230901 INTRODUCTION Acquired ungual fibrokeratomas are uncommon benign fibrous tumors of the nail unit. These tumors can emerge from the proximal nail fold, directly from the nail bed itself,[1] as well as from other areas of the nail unit. [Extracted from the article]

Our patient represents the first reported case of neoadjuvant immune checkpoint inhibitor (ICI) therapy for stage II melanoma. At this time, surgical resection and adjuvant therapy remain the standard of care for high-risk stage II and clinical stage III melanoma.[1] However, appropriate patients can be considered for neoadjuvant therapy in ongoing clinical trials. [Extracted from the article]

Melanoma of the nail apparatus is challenging to diagnose for both dermatologists and dermatopathologists. Misdiagnosis or delayed diagnosis of nail unit melanoma can have fatal consequences and legal ramifications. This review educates dermatopathologists on challenges and traps they should be aware of to avoid misdiagnosis of nail unit melanoma. We present illustrative difficult cases that introduce several themes regarding challenges in the diagnosis of nail unit melanoma: specimens with subtle histopathologic findings, challenges in immunoperoxidase interpretation, and how clinical knowledge and surgical procedural knowledge are mandatory to make the diagnosis. Dermatopathologists will be aware of when and how to suspect nail unit melanoma in unusual circumstances. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is Available in the Text. BACKGROUND: Few prospective studies have evaluated local recurrence rates (LRR) after excision of desmoplastic melanoma (DM); however, several retrospective studies have reported high LRR. OBJECTIVE: To determine LRR after excision of DM and evaluate factors affecting LRR. MATERIALS AND METHODS: Systematic review of the PubMed, Embase, and Web of Science databases was performed to identify studies reporting local recurrence after excision of DM with conventional wide local excision (WLE), Mohs micrographic surgery (MMS), or staged excision (SE). Meta-analysis was performed to calculate summary LRR and pooled risk ratios (RR). RESULTS: Literature search identified 4 studies evaluating MMS or SE (total n = 61 DM). 53 studies assessed WLE (n = 3,080) and were analyzed quantitatively. The overall LRR after WLE of DM was 21% (95% CI, 0.16–0.28; n = 2,308). Local recurrence rate was higher with positive/unknown histologic excision margins (49%, 95% CI, 0.25–0.74; n = 91) versus negative histologic margins (11%, 95% CI, 0.07–0.17; n = 1,075; [ p <.01]). Neurotropism was also associated with increased LRR (RR, 1.79; 95% CI, 1.34–2.38, p <.01; n = 644). CONCLUSION: DM has high LRR after WLE. Local recurrence risk was greatest with positive excision margins, indicating the importance of achieving negative microscopic margins. Greater study of MMS and SE for DM is required. [ABSTRACT FROM AUTHOR]

Background: Programmed cell death protein (PD‐1) and programmed death‐ligand 1 (PD‐L1) inhibition checkpoint blockade leads to various cutaneous adverse reactions, including bullous pemphigoid and lichen‐planus‐like reactions. However, lichen planus pemphigoides (LPP), manifesting histopathologic features of both lichen planus and bullous pemphigoid, has more rarely been associated with immunotherapy. Methods: The clinical and histopathologic findings of three patients were examined, and a review of cases of LPP and bullous lichen planus secondary to PD‐1 inhibitor therapy was performed. Results: Three patients (two with advanced non‐small‐cell lung adenocarcinoma and the third with metastatic breast cancer) presented with both lichenoid eruptions and bullae. Biopsy of the lesions revealed lichenoid tissue reactions in all three patients. Together with the histopathologic findings, direct immunofluorescence (DIF) showing linear C3 and IgG deposition and positive enzyme‐linked immunosorbent assay (ELISA) showing BP180 positivity supported a diagnosis of LPP in two patients. The third patient in our series also showed confirmatory ELISA testing supporting LPP. Conclusions: Lichen planus pemphigoides is a distinct cutaneous toxicity to checkpoint inhibitor therapy illustrates a possible pathogenic mechanism and the importance of dermatopathology recognition to render an accurate diagnosis. [ABSTRACT FROM AUTHOR]

In another study,7 in which different colors of nail polish and different brands of nail polish were studied, similar patterns for the nail polish were seen except that the finely granular material was mostly polarizable. In the 19th century, nail cosmetics became more commonly used worldwide; nail polish itself was popularized in the 20th century and many different forms of nail cosmetics were introduced to the fashion industry, including basic nail polish, gel nail polish, acrylics, breathable nail polish, and others.1 In the last few decades, further innovations have been made in nail art, introducing various forms of nail polish and nail stickers.2 Magnetic nail polish is a new trend in nail cosmetics that is quickly becoming popular. For example, the acrylate ingredient, which is also present in this magnetic nail polish, is the main allergenic component among most types of nail polishes, including acrylic nails, gel nails, solar nails, ultraviolet nails, nail wraps, and silk nails. [Extracted from the article]

Interestingly, comparison of the histopathologic findings of the annular EO lesions in patients with and without systemic sarcoidosis showed only minor differences.5 In patients with systemic sarcoidosis, the zonal pattern on histopathology was less defined. Only 1 patient had skin lesions outside of the area of EO, but it was not reported whether this patient had systemic sarcoidosis or cutaneous lesions only. Keywords: ochronosis; exogenous; exogenous ochronosis; perforating; granulomatous EN ochronosis exogenous exogenous ochronosis perforating granulomatous 1219 1222 4 09/21/21 20211001 NES 211001 Introduction Exogenous ochronosis (EO) is a cutaneous disorder induced by cosmetic application of skin lightening agents, most commonly hydroquinone.1 The pathogenesis is secondary to inhibition of local activity of homogentisic acid oxidase by hydroquinone, leading to accumulation of homogentisic acid that polymerizes to form ochronotic pigment in the skin. AG-like change in EO has been reported in a patient who presented with annular lesions on a background of severe EO.7 Of note, in AG, elastophagocytosis is a prominent feature, which is absent in actinic granuloma-like EO. [Extracted from the article]