Dermoscopic diagnosis of subungual hematoma: new observations

Abstract

Introduction: There are very few studies focusing on the dermoscopic features of subungual hematoma which is one of the major imitators of subungual melanoma.

Aim: To identify the dermoscopic findings of subungual hematoma, which will facilitate the diagnostic process by reducing the use of more invasive diagnostic methods like nail avulsion or biopsy.

Material and methods: In this study, clinical and dermoscopic findings of the cases were reviewed. The diagnosis of subungual hematoma was confirmed by observing progression of the colour change to the distal edge of the nail plate in all the cases.

Results: A total of 47 subungual hematomas were enrolled in the study. The most common colour was purple-black (53%). Blue-white colour was observed in 12 (26%) lesions. 9 (19%) lesions showed granular leukonychia. All of the lesions had a homogenous pattern. In 25 (53%) lesions, a globular pattern was observed. 14 (30%) lesions showed a streaks pattern. Peripheral fading and periungual haemorrhage were present in 14 (30%) and 9 (9%) lesions, respectively.

Conclusions: We detected two new findings which have not been described previously for subungual hematoma: the first one is "blue-white colour" which is known as an important clue to melanoma. The second one is granular leukonychia localized on the hematoma. We suggest that in any case of the nail discoloration, a thorough dermoscopic examination should be performed. Moreover, progression of the colour change to the distal edge should be observed to ensure that a possible melanoma is not overlooked.

Keywords: dermoscopy; hematoma; subungual.

Figure 1

A – Homogeneous pattern with purple black (blue arrow) and purple (white arrow) colours, streaks pattern with black colour (black arrow), B – homogenous pattern with purple black (black arrow) and purple (blue arrow) colours. Globular pattern with redcolour (red arrow). Peripheral fading (white arrow)

Figure 2

A – Homogenous pattern with purple black colour (black arrow), sharp edge (red arrow), globular pattern with red black colour (white arrow), peripheral fading (blue arrow), white jagged edges (green arrow), B – homogenous pattern with brown (red arrow), grey (yellow arrow), black (black arrow) and blue white (blue arrow) colours, white longitudinal striae (white arrow)

Figure 3

A – Homogenous pattern with blue white (white arrow) and streaks pattern with purple black (black arrow) colours, B – homogeneous pattern with black colour (white arrow), globular pattern with red colour (red arrow), sharp edge (blue arrow), peripheral fading with red colour (green arrow). Granular leukonychia (yellow arrow)