目的:文献中讨论了小儿黑甲的自然史和活检排除黑色素瘤的必要性。我们假设在接受甲癣甲床活检的小儿患者中,恶性指甲病理学的发生率较低。
方法:我们在2007年至2022年期间,对一家机构的54例儿童患者(年龄<18岁)进行了回顾性图表回顾,这些患者表现为黑甲癣并接受了甲床活检。收集的数据点包括患者人口统计学,病史,体检结果,病理报告,和临床照片。进行单变量和多变量分析以评估与高风险病理结果相关的危险因素。
结果:黑甲癣发病的平均年龄为5.5岁(SD4.4)。首次活检的平均年龄为7.8岁(SD4.3)。体检时,27例患者至少有四个与黑色素瘤有关的特征(不对称性,边界不规则,颜色异质性,直径>1/3的指甲,不断变化的颜色,不断演变的直径,哈钦森的标志)。最常见的病理诊断是黑素细胞痣(35%),具有良性特征的非典型表皮内黑素细胞增生(AIMP)(24%),甲下扁豆(22%),和AIMP相关功能(17%)。没有原位黑色素瘤或侵袭性恶性黑色素瘤的病例。关于多元回归,与更多相关病理相关的唯一显著危险因素(具有相关特征的AIMP)是进行活检的日历年(系数=-0.34,P=0.016).体检特征与高危病理之间没有关联。12例患者手术再次切除病灶,其中6例是由于AIMP切除不完全,具有相关特征,其中6例是由于复发。
结论:我们的病例系列没有发现任何由儿童黑甲癣引起的原位黑色素瘤或恶性黑色素瘤病例。具有相关特征的非典型表皮内黑素细胞增生仅与活检的年份相关。这可能反映了对小儿黑甲癣的认识有所提高,尽管其病理特征令人担忧,但通常是良性的。在小儿黑甲癣中进行指甲基质活检的决定应基于患者父母之间的合作讨论,皮肤科医生,和整形外科医生。
OBJECTIVE: The natural history of pediatric melanonychia and the necessity of biopsy for ruling out melanoma are debated in the literature. We hypothesize that there is a low rate of malignant nail pathology among pediatric patients undergoing nail bed biopsy for melanonychia.
METHODS: We performed a retrospective chart review of 54 pediatric patients (age <18 years) at a single institution who presented with melanonychia and underwent nail bed biopsy from 2007 to 2022. Data points collected included patient demographics, medical history, physical exam findings, pathology
reports, and clinical photos. Univariate and multivariate analyses were performed to assess for risk factors associated with high-risk pathology findings.
RESULTS: The average age of melanonychia onset was 5.5 years (SD 4.4). The average age of first biopsy was 7.8 years (SD 4.3). On physical exam, 27 patients had at least four features concerning for melanoma (asymmetry, border irregularity, color heterogeneity, diameter > 1/3 of nail, evolving color, evolving diameter, Hutchinson\'s sign). The most common pathology diagnoses were melanocytic nevus (35%), atypical intraepidermal melanocytic proliferation (AIMP) with benign features (24%), subungual lentigo (22%), and AIMP with concerning features (17%). There were no cases of melanoma in situ or invasive malignant melanoma. On multivariate regression, the only significant risk factor associated with more concerning pathology (AIMP with concerning features) was the calendar year in which biopsy was performed (coefficient = -0.34, P = 0.016). There was no association between physical exam features and high-risk pathology. Twelve patients had surgical re-excision of the lesion, 6 of which were due to incomplete excision of AIMP with concerning features and 6 of which were due to recurrence.
CONCLUSIONS: Our
case series did not find any cases of melanoma in situ or malignant melanoma arising from pediatric melanonychia. Atypical intraepidermal melanocytic proliferation with concerning features was associated only with the year in which the biopsy was performed, which may reflect the improved understanding of pediatric melanonychia as often benign despite concerning features on pathology. The decision to perform a nail matrix biopsy in pediatric melanonychia should be based on a collaborative discussion between the patient\'s parents, dermatologist, and plastic surgeon.