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Brown line on nail

Discussion in 'General Issues and Discussion Forum' started by mike weber, Jul 5, 2011.

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    Hi Folks

    Patient came in this morning with a GP diagnosed ´ingrowing toe nail´

    Its not - Some sort of Beaus line - Dermatology not my strong area.

    The patient is healthy 33 years old of Asian origin
    Takes no medication
    Is not or has not been pregnant
    not trauma related problems

    The brown/grey line is about 2-3 mm wide and has been present for about 12months.

    I can get a better photo if required.

    PS Patient read in a magazine that nails lines are a sign of Cancer so is a little stressed for information.

    If it is a sign of a systemic condition as I know beaus lines can be please supply information so I can get the GP to undertake the appropriate tests.


    PPS was going to send an email to Bel but thought it maybe interesting - so pressure is on now Bel.

    Attached Files:

  2. So Photo not the greatest - Ive drawn a line over the line in question

    Attached Files:

  3. daisyboi

    daisyboi Active Member

    Cant really tell on the photo but could this be a splinter haemorrhage? I think the most common cause is localised trauma leading to capillary damage. They are also a symptom of late stage endocarditis but I think other symptoms would have been present long prior to splinter haemorrhaging so this is unlikely to be the first sign if such a condition is present. Just my thoughts.
  4. blinda

    blinda MVP

    Nice hx Mike. Thanks for the clarification of which line you were referring to. You threw me when you said `Beaus line` - these are transverse.

    Longitudinal melanonychia (non- malignant melanin in the nail plate) is actually quite commonly seen in middle-aged Asian and Afro-Caribbean patients. Whereas, transverse melanonychia is rare and usually associated with chemotherapeutic meds and antimalarials, such as infliximab, and exposure to radiation ie X-ray therapy.

    Other causes;

    • pigmented mole
    • trauma (haematoma)
    • onychomycosis
    • bacterial infection
    • lichen planus
    • And of course the one to rule out, MM (malignant melanoma)

    Melanomas arise from the matrix, whereas a trauma induced subungal haematoma may develop anywhere. Clinical decision can be aided with observation of whether it `grows out` with the nail, as haematoma does. If this pt has had a melanotic streak from the matrix for 12 months I would definitely refer for biopsy. It is never inappropriate to refer such a case for biopsy as morbidity due to subungal melanoma is high. Remember Bob;


    Can`t get enough reggae at the mo.....sorry, no more bar talk chaps ;)

  5. So Bel you would put your internet money on -
    and next step is - nail biopsy ?
  6. blinda

    blinda MVP

    Yep, If I were a gambling kinda gal, I`d put it on non-malignant longitudinal melanonychia.

    But, I would still send for biopsy to rule out acral lentiginous melanoma, even if the GP disagrees. I have been known to refer directly to dermatology when my clinical judgement tells me to do so.
  7. champion thanks
  8. blinda

    blinda MVP

    No problem. It`s your round I believe?:drinks
    You are right about Beaus lines being associated with systemic disease, BTW. However, in this case the line is longitudinal and stems from the PNF, so I would say the lesion is due to local pathology in the matrix. It`s now a matter of determining whether it is malignant or not.

    Sorry daisyboi, just occurred to me that I completely ignored your post.

    Splinter haemorrhage is a reasonable possibility but, as you rightly pointed out, they usually appear late in endocarditis, so other symptoms would have manifested long before. They are also associated with other auto-immune and inflammatory pathologies which result in this subungal vasculitis. However, splinter haemorrhages also `grow out` with the nail and generally do not stem from the matrix as this lesion appears to.

  9. Barbthepod

    Barbthepod Member

  10. Bel might be a good one for your extra homework assignment;) maybe ?
  11. blinda

    blinda MVP

    Nice one Barb :drinks Hope business is good. Catch up soon.

    Extra homework? What did I do wrong? Sorry Sir, will try harder.

  12. W J Liggins

    W J Liggins Well-Known Member

    Sorry to come into this one late.

    What about the possibility of a junctional naevus Bel? Quite agree it needs biopsy.

    All the best

  13. blinda

    blinda MVP

    Too predictable. `Twas a toss up between Jethro Tull and this one;


    My hippy side won.

    Hi Bill,

    Yep, I would have included that in `pigmented mole`, although I appreciate there are differences.

    Must have a word with you about my osteophyte. Becoming more painful....


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