Longitudinal Melanonychia

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I am just curious as to whether or not I should consider getting a second opinion.

I have a 1 mm line on my left thumbnail. I am 33 years old, female, and caucasian. It appeared at the beginning of the year, and depending on how you look at it, it almost appears to run from the cuticle to the free edge of the nail plate. With a lightsource behind the thumb, however, it very clearly stops about 4 mm from the cuticle.

It's a pale color, purplish-bronzy in most lights, and not terribly obvious. It has very definite borders on each side, and is absolutely uniform in color.

My derm has looked at it twice, very closely, measured it, and took a picture of it. He says it is absolutely nothing to worry about, and that it is most likely the result of a nail bed trauma ( I vaguely remember slamming a thumb in a drawer around the holidays, but cannot swear to which thumb it was) of some sort. He classed it as a melanonychia, but he also said it could be a subungual hematoma that is just going to take quite a long time to resolve, if ever. He said sometimes trauma can damage the nail plate and create a permanent void. He also said it's the lightest one he's ever seen, and agrees that depending on the light source, it's hard to tell where it ends.

He also said, if I had shown it to him incidentally during my yearly exam, he would have classed it as nothing to worry about. He only measured it and took pictures because I came in specifically for that issue.

I asked him about a biopsy, because every scrap I've read on single digit melanonychia seems to demand a biopsy, but he says he feels that this isn't suspicious at all. He said he'd be happy to check it out again in six months, to confirm for me that it's stable, but he's very comfortable in telling me that it's not a malignancy.  

Would you recommend another opinion? I want to trust my doctor, and he's been terrific, but when the literature seems to insist on a biopsy...... I worry.

Is this a watch and wait situation?

[Alan Rockoff, MD]

That's a tricky question.  If it's from trauma, it ought to grow out in 3-4 months, which doesn't sound as though it's happening.  Without seeing it, I would say that pigmented bands are sufficiently uncommon in Caucasians that a biopsy might need to be considered, but a biopsy of a nail is not a trivial procedure.  If it doesn't grow out in 3 months (or hasn't done so), I would consult a dermatologist who specializes in nail disorders, or else a pigmented lesion clinic.  Academic medical centers are likely to have one or both.  The second opinion will probably concur with the first, but I think is worth soliciting.

Best.

Dr. Rockoff

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Thank you.

My doctor is the head of the department at our university for this (nail disorders), so I'll call around to another university, and see what I can find out about being evaluated. Luckily, I live in an area with two wonderful med schools in close proximity.

Thanks!

[Alan Rockoff, MD]

OK.  But if you've already seen a nail specialist, I doubt you'll get a different opinion.

Dr. Rockoff

[JH0703]

On August 28, 2005,I went to a dermatologist because I have problems with my hands breaking out.  When she was checking my hands, she noticed a stripe on my right ring finger nail.  She asked me if anyone in my family had ever had melanomia and I told her no.  She immediately said for me to get to UCI Medical (University of California, Irvine Medical). She put a request in for me but they do not have an opening until November 9,2005. I have called at least 4 times a week checking to see if they have a cancellation but they never do.  Naturally I am very concerned and today I thought of looking up this problem on the internet and I came across your company.  What can you tell me about this problem?  I am really scared.

Thank you

Jh0703 (Josephine Hicks)