Ask a Dermatology Question, Get an Answer ASAP!
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My name is***** khan. I am board certified family physician with specialist training in dermatology. I shall try and help you today with your query.
Let me have a quick read through and I’ll get back to you shortly.
to begin with, can you upload a picture please?
Hi, let me have a look
is it just one nail or many nails are involved?
when did you first notice it, any symptoms?
give me a couple of minutes to type the answer
No thats OK.
By the looks of it, it appears as melanonychia.
The term melanonychia describes a black-brown-gray pigmentation of the nail plate that, in most cases, appears as a longitudinal band. Melanonychia can be observed at any age, affecting one digit or several digits, in both fingernails and toenails.
However, only a picture can not say that it is a benign pigmentation. It needs to be seen under dermatoscopy to rule out sinister causes like melanoma especially if the history is short and secondly due to your ethnic origin.
I would suggest that you see your Gp regarding this. This is probably nothing to worry about but should be seen in person.
In Asians generally, melanomas are low but acral melanomas i.e the ones which appear on hands and feet are higher in incidence.
if you have a history of trauma recently it is quite likely that it might have appeared secondary to that.
In this case,One of the other things that you can do is to give it a couple of weeks and monitor its progress with a photograph. If it fades then its nothing to worry but if remains the same then you must see your GP to be referred to dermatologist.
Gps dont do dermoscopy, but if they have a Gp with special interest in dermatology in your area, that referral might be quicker and easier for them.
I think that would be the sensible thing to do and will put your mind at rest too.
I hope this answers your question.
If you are happy with the response, Can I ask you to take some time to rate the consultation? Your feedback is very important for my professional growth and also for the fact that until you have rated the consultation we do not get paid for our work.
This does not mean that your query gets closed after that. You can come back as many times as you like through the thread and ask me further questions regarding this problem.
Best wishes and good luck.
thank you. I hope it turns out all good.
you are absolutely right with the above information. That's the reason why I said that grossly it appears as benign melanonychia and it is very likely that it has appeared secondary to injury but I am just being more careful and looking at it under dermatoscope will completly rule out sinister causes.
2 weeks wait is appropriate to wait.
Subungual melanomas represent approximately 20% in dark-skinned and oriental populations compared to about 2% of cutaneous melanomas in white populations. There have been cases where subungal melanomas have occurred secondary to direct injury.
We are just being more cautious in your case. grossly it appears OK.
I have not seen them personally but this does not mean they do not happen.
We don't just rely on personal experiences but look at the research and evidence and give you advice accordingly.
Telemedicine can only guide you towards the next appropriate step but can not make an accurate 100% diagnosis. We have previously had cases on teledermatology where the lesions have looked completely benign but turned out malignant on biopsies and dermoscopy. That is why it has changed our attitude towards dealing with such cases. I am very hopeful that this is being but without dermoscopy, I can only give you a probable diagnosis.
This does not seem anything significant.
With Nail pigmentation, the number of affected digits is an important diagnostic clue: if more than one nail is involved, the first clinical suspicion should be a benign condition due to melanocytic activation. The most common causes of multiple digit NP are racial pigmentation, systemic disorders, exogenous pigment, drug induction and mechanical triggers . For this reason, taking a good medical history and a full body examination is mandatory in order to reach a correct diagnosis. Mention this to the dermatologist too. to me it looks more like racial pigmentation but more detailed history and examination is needed.
I hope all goes well tomorrow. let me know.
I can understand all your anxiety.
Sometimes when the patients are too stressed and nothing else would reassure them, we do do a test to confirm it for them. This might be one of the reasons, one of the consultants might have mentioned it. personally, as I told you before as well that this looked benign and two consultants confirming this is good enough.
The wait and watch policy looks sensible. You keep monitoring it for now. If they have given you a follow up appointment in 3 months that is good enough.
No worries. You are welcome.