中华皮肤科杂志 ›› 2021, Vol. 54 ›› Issue (11): 993-997.doi: 10.35541/cjd.20200881

• 研究报道 • 上一篇    下一篇

266例黑甲性皮损的皮肤镜特点分析

闫东    郭艳阳    张宇伟    海璐明    高天文    朱冠男   

  1. 第四军医大学西京皮肤医院，西安  710032
  • 收稿日期:2020-09-04 修回日期:2021-08-17 发布日期:2021-11-01
  • 通讯作者: 朱冠男 E-mail:zhugn@fmmu.edu.cn
  • 基金资助:
    国家自然科学基金

Dermoscopic features of 266 cases of melanonychia

Yan Dong, Guo Yanyang, Zhang Yuwei, Hai Luming, Gao Tianwen, Zhu Guannan   

  1. Department of Dermatology, Xijing Hospital, The Fourth Military Medical University, Xi′an 710032, China
  • Received:2020-09-04 Revised:2021-08-17 Published:2021-11-01
  • Contact: Zhu Guannan E-mail:zhugn@fmmu.edu.cn
  • Supported by:
    National Natural Science Foundation of China

PDF

30

摘要： 【摘要】 目的 比较临床常见黑甲性疾病的皮肤镜表现及特点。方法 回顾性分析2016年1月至2020年7月在第四军医大学西京皮肤医院行皮肤镜检查的4种常见黑甲皮损皮肤镜图像特征。结果 共纳入266例黑甲性皮损，其中甲黑素瘤64例（24.1%），甲母痣52例（19.5%），甲下出血89例（33.5%），甲真菌病61例（22.9%）。甲黑素瘤及甲母痣多发于指甲，甲黑素瘤发生于拇指甲的比例高（62.8%），甲母痣则更多发生于2 ~ 5指甲（73.9%）；甲下出血及甲真菌病多发于趾甲，其中甲下出血51例（57.3%），甲真菌病46例（75.4%）。甲黑素瘤好发于40岁以上患者（49例，76.8%），其余3组疾病则多见于40岁以下患者。甲黑素瘤皮肤镜表现主要为纵向规则条带（35例，54.7%）或不规则条带（25例，39.0%），87.5%的病例色素带宽度大于3 mm， 36例（56.3%）Hutchinson征阳性， 15例（23.4%）破溃，颜色以黑褐色为主；甲母痣表现为单一规则色素带结构（52例，100%），36例（69.2%）色素带宽度小于3 mm，26例（50%）Hutchinson征阳性，无破溃病例；甲下出血表现为弥漫性斑疹（74例，83.1%），85例（95.5%）见暗红色或黑色出血小球结构；黑甲性甲真菌病表现为黑褐色纵向不规则条带（54例，88.5%）。结论 皮肤镜下，甲黑素瘤可表现为纵向规则条带，条带宽幅大于3 mm，甲母痣多表现为纵向规则条带，甲下出血表现为弥漫性污斑，甲真菌病可表现为纵行不规则条带。皮肤镜可用于鉴别黑甲性皮损，为甲黑素瘤辅助诊断提供依据。

关键词: 指（趾）甲疾病, 痣和黑素瘤, 甲癣, 皮肤镜检查, 甲下血肿, 纵向黑甲

Abstract: 【Abstract】 Objective To investigate dermoscopic manifestations and features of melanonychia. Methods A retrospective analysis was carried out on dermoscopic images of 4 common types of melanonychia collected in Department of Dermatology, Xijing Hospital, the Fourth Military Medical University from January 2016 to July 2020. Results A total of 266 cases of melanonychia were collected, including 64 （24.1%） of subungual melanoma, 52（19.5%）of nail matrix nevi, 89 （33.5%） of subungual hemorrhage, and 61 （22.9%） of onychomycosis. Subungual melanoma and nail matrix nevi mostly occurred in the fingernails. To be specific, subungual melanoma most frequently occurred in the thumbnails （62.8%）, while nail matrix nevi mostly involved the 2nd - 5th fingernails （73.9%）. Subungual hemorrhage and onychomycosis mostly occurred in the toenails, and there were 51 （57.3%） cases of subungual hemorrhage of the toenails and 46 （75.4%） cases of onychomycosis of the toenails. Subungual melanoma mostly occurred in patients aged over 40 years （49 cases, 76.8%）, while the other 3 types of melanonychia mostly affected patients aged under 40 years. Dermoscopic manifestations of subungual melanoma mainly included regular longitudinal bands （35 cases, 54.7%） or irregular bands （25 cases, 39.0%） whose width was greater than 3 mm in 87.5% cases, Hutchinson sign （36 cases, 56.3%）, and ruptures （15 cases, 23.4%） which mainly were black-brown in color; dermoscopic manifestations of nail matrix nevi mainly were a single regular pigmented band （52 cases, 100%） whose width was less than 3 mm in 36 （69.2%） cases, and Hutchinson sign （26 cases, 50%）, while no ruptures were observed in nail matrix nevus lesions; subungual hemorrhage dermoscopically manifested as diffuse macules （74 cases, 83.1%）, and globular dark red or black hemorrhagic structures were observed in 85 （95.5%） cases; fungal melanonychia was dermoscopically characterized by irregular dark brown longitudinal bands （54 cases, 88.5%）. Conclusions Subungual melanoma was dermoscopically characterized by regular longitudinal bands with a width of greater than 3 mm, nail matrix nevi by regular longitudinal bands, subungual hemorrhage by diffuse macules, and onychomycosis by irregular longitudinal bands. Dermatoscopy can be used to identify melanonychia lesions and provide a basis for auxiliary diagnosis of subungual melanoma.

Key words: Nail diseases, Nevi and melanomas, Onychomycosis, Dermoscopy, Subungual hematoma, Longitudinal melanonychia