American Association of Plastic Surgeons

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Clinical And Histopathological Investigation Of Pediatric Melanonychia
Omar Ani, MD1, Wen Xu, MD, MTR2, Benjamin Chang, MD2, Ines C. Lin, MD2;
1Perelman School of Medicine University of Pennsylvania, Philadelphia, PA, USA, 2Hospital of the University of Pennsylvania, Philadelphia, PA, USA

PURPOSE: The natural history of pediatric melanonychia and the necessity of biopsy for ruling out melanoma are debated. We hypothesize that there is a low rate of malignant nail pathology amongst pediatric patients undergoing nail bed biopsy for melanonychia.
METHODS: A retrospective chart review of pediatric patients (age <18 years) who underwent nail bed biopsy for melanonychia from 2007-2022 identified 54 patients. Clinical history, exam, pathology, and clinical photos were collected with subsequent univariate and multivariate analyses.
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. The most common pathology diagnoses were melanocytic nevus (35%) followed by 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, there was no association between physical exam features and high-risk pathology. Twelve patients had surgical re-excision, 6 of which were due to incomplete excision of a concerning pathology (AIMP with concerning features) and 6 of which were due to recurrence.
CONCLUSION: Our biopsies yielded no cases of melanoma in situ or malignant melanoma arising from pediatric melanonychia nor any correlation between clinical findings and concerning atypia. The decision to perform a nail matrix biopsy in pediatric melanonychia should be based on a collaborative discussion between the patientís parents, dermatologist, and plastic surgeon.
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