Longitudinal Melanonychia in Children

Abstract

BACKGROUND AND DESIGN: Longitudinal melanonychia is rare in white children and represents a difficult clinical challenge. Because of the fear of malignant melanoma, a surgical excision is usually performed, sometimes with definitive aesthetic and functional consequences. Eight children with longitudinal melanonychia who were between the ages of 2 and 14 years underwent follow-up. Surgical excision was performed in five cases. For three children, a wait-and-see policy was adopted, because their longitudinal melanonychia had been unchanged for years at the time of their examination. RESULTS: Melanoma was never observed in our cases (follow-up, 5.5 years). Histologic examinations performed in five cases showed junctional nevi of the nail matrix, often with dysplasia as commonly seen in juvenile nevi. Two children had postoperative nail dystrophy. CONCLUSION: In white children, longitudinal melanonychia rarely disappears. Since an ungual melanocytic band can appear at the age when other nevi appear, surgical excision should not be undertaken on different grounds than for other congenital or acquired nevi in children.