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Dealing with Melanonychia
Antonella Tosti, MD, Bianca Maria Piraccini, MD, and Débora Cadore de Farias, MD
Melanonychia describes a brown or black pigmentation of the nail plate caused by the presence of melanin. In this article, we review possible causes of melanonychia and discuss the main problems of management of patients with this condition. The goal in the management of melanonychia is early diagnosis of melanoma of the nail matrix and bed. Melanoma of the nail bed is also known as subungual melanoma. We discuss clinical, dermoscopic features that may help the clinician in selecting lesions that should have excisional biopsy and evaluate different options for the excision. Addressing melanonychia is still a difficult task, and the correct management of pigmented bands in children is far from established. Dermoscopy is possibly a useful tool but the real benefit of this technique, screening lesions to determine which ones need to be removed, remains to be proven.
*For a PDF of the full article, click on the link to the left of this introduction.
Antonella Tosti, MD, Bianca Maria Piraccini, MD, and Débora Cadore de Farias, MD
Melanonychia describes a brown or black pigmentation of the nail plate caused by the presence of melanin. In this article, we review possible causes of melanonychia and discuss the main problems of management of patients with this condition. The goal in the management of melanonychia is early diagnosis of melanoma of the nail matrix and bed. Melanoma of the nail bed is also known as subungual melanoma. We discuss clinical, dermoscopic features that may help the clinician in selecting lesions that should have excisional biopsy and evaluate different options for the excision. Addressing melanonychia is still a difficult task, and the correct management of pigmented bands in children is far from established. Dermoscopy is possibly a useful tool but the real benefit of this technique, screening lesions to determine which ones need to be removed, remains to be proven.
*For a PDF of the full article, click on the link to the left of this introduction.
Antonella Tosti, MD, Bianca Maria Piraccini, MD, and Débora Cadore de Farias, MD
Melanonychia describes a brown or black pigmentation of the nail plate caused by the presence of melanin. In this article, we review possible causes of melanonychia and discuss the main problems of management of patients with this condition. The goal in the management of melanonychia is early diagnosis of melanoma of the nail matrix and bed. Melanoma of the nail bed is also known as subungual melanoma. We discuss clinical, dermoscopic features that may help the clinician in selecting lesions that should have excisional biopsy and evaluate different options for the excision. Addressing melanonychia is still a difficult task, and the correct management of pigmented bands in children is far from established. Dermoscopy is possibly a useful tool but the real benefit of this technique, screening lesions to determine which ones need to be removed, remains to be proven.
*For a PDF of the full article, click on the link to the left of this introduction.
Tips and Tricks in Nail Surgery
Philippe Abimelec, MD
Nail surgery is part of the dermatologist’s armamentarium but it is often an afterthought in teaching dermatologic surgery. We will offer some practical hints about instruments and supplies, evaluation of pigmented lesions to determine whether a biopsy is needed, local anesthesia, and surgical techniques that should make procedures of the nail unit more efficient, less painful, and less likely to result in complications.
*For a PDF of the full article, click on the link to the left of this introduction.
Philippe Abimelec, MD
Nail surgery is part of the dermatologist’s armamentarium but it is often an afterthought in teaching dermatologic surgery. We will offer some practical hints about instruments and supplies, evaluation of pigmented lesions to determine whether a biopsy is needed, local anesthesia, and surgical techniques that should make procedures of the nail unit more efficient, less painful, and less likely to result in complications.
*For a PDF of the full article, click on the link to the left of this introduction.
Philippe Abimelec, MD
Nail surgery is part of the dermatologist’s armamentarium but it is often an afterthought in teaching dermatologic surgery. We will offer some practical hints about instruments and supplies, evaluation of pigmented lesions to determine whether a biopsy is needed, local anesthesia, and surgical techniques that should make procedures of the nail unit more efficient, less painful, and less likely to result in complications.
*For a PDF of the full article, click on the link to the left of this introduction.
Matrix Biopsy of Longitudinal Melanonychia and Longitudinal Erythronychia: A Step-by-Step Approach
Frozen Glove Found to Prevent Docetaxel-Induced Onycholysis
SAN ANTONIO — Having breast cancer patients don a pair of flexible frozen gloves during infusion of docetaxel markedly reduced the chemotherapy-induced fingernail toxicity known as onycholysis in a phase II multicenter Japanese trial.
This nail finding confirms an earlier French report, but the Japanese team was unable to confirm another French finding that these same frozen gloves also prevent docetaxel (Taxotere)-induced skin toxicity (J. Clin. Oncol. 2005;23:4424–9), Dr. Takahiro Nakayama said at the San Antonio Breast Cancer Symposium.
The Elasto-Gel frozen gloves, which look like cobalt-blue bulbous mittens or boxing gloves, contain a glycerin-based gel that remains soft at low temperatures. The reusable gloves, made by Southwest Technologies Inc., of Kansas City, Mo., are charged up by being placed in a subzero freezer for several hours. They contain an inner disposable liner that prevents direct skin contact with the icy material.
Recently a group at Georges Pomidou European Hospital in Paris reported in a phase II case-control study that an Elasto-Gel frozen sock significantly reduced docetaxel-induced toenail onycholysis but not cutaneous toxicity (Cancer 2008;112:1625–31).
Dr. Nakayama, a breast surgeon at Osaka University, Japan, reported on a comparative trial involving 70 breast cancer patients who used the frozen gloves and 52 others who were not offered them. The gloves are worn for 90 minutes, beginning 15 minutes prior to a 60-minute infusion of docetaxel. Because the gloves tended to warm up beyond the critical 0-degree Celsius threshold too quickly, investigators had subjects swap them for a fresh pair midway through the treatment session.
The mechanism of benefit is thought to involve reduced blood flow to the nail, Dr. Nakayama said in an interview.
No onycholysis occurred in 41% of the gloved group compared with 8% of controls. Rates of grades 1–3 fingernail damage as defined in National Cancer Institute Common Toxicity Criteria were significantly lower in the gloved patients.
However, rates of skin toxicity—rash, peeling, induration, fibrosis, hyperpigmentation, or hand-foot syndrome—did not differ significantly between the two groups. One-third of the gloved patients had no skin changes, as did 44% of controls. Half of the gloved group experienced grade 1 skin toxicity, compared with 42% of controls. Grade 2 toxicity occurred in 17% of gloved patients, while grade 2/3 toxicity was noted in 14% of controls.
Dr. Nakayama said he and his coinvestigators have concluded that the frozen gloves, with their lack of side effects, are a useful advance in supportive care and merit inclusion in routine clinical practice. “We use this in the clinic now on a daily basis,” the surgeon added.
He contends, however, that the design can be improved upon, and has partnered with a Japanese manufacturer in developing a more efficient glove. They also plan to develop a frozen sock.
The frozen glove study was partially supported by Sanofi-Aventis.
ELSEVIER GLOBAL MEDICAL NEWS
SAN ANTONIO — Having breast cancer patients don a pair of flexible frozen gloves during infusion of docetaxel markedly reduced the chemotherapy-induced fingernail toxicity known as onycholysis in a phase II multicenter Japanese trial.
This nail finding confirms an earlier French report, but the Japanese team was unable to confirm another French finding that these same frozen gloves also prevent docetaxel (Taxotere)-induced skin toxicity (J. Clin. Oncol. 2005;23:4424–9), Dr. Takahiro Nakayama said at the San Antonio Breast Cancer Symposium.
The Elasto-Gel frozen gloves, which look like cobalt-blue bulbous mittens or boxing gloves, contain a glycerin-based gel that remains soft at low temperatures. The reusable gloves, made by Southwest Technologies Inc., of Kansas City, Mo., are charged up by being placed in a subzero freezer for several hours. They contain an inner disposable liner that prevents direct skin contact with the icy material.
Recently a group at Georges Pomidou European Hospital in Paris reported in a phase II case-control study that an Elasto-Gel frozen sock significantly reduced docetaxel-induced toenail onycholysis but not cutaneous toxicity (Cancer 2008;112:1625–31).
Dr. Nakayama, a breast surgeon at Osaka University, Japan, reported on a comparative trial involving 70 breast cancer patients who used the frozen gloves and 52 others who were not offered them. The gloves are worn for 90 minutes, beginning 15 minutes prior to a 60-minute infusion of docetaxel. Because the gloves tended to warm up beyond the critical 0-degree Celsius threshold too quickly, investigators had subjects swap them for a fresh pair midway through the treatment session.
The mechanism of benefit is thought to involve reduced blood flow to the nail, Dr. Nakayama said in an interview.
No onycholysis occurred in 41% of the gloved group compared with 8% of controls. Rates of grades 1–3 fingernail damage as defined in National Cancer Institute Common Toxicity Criteria were significantly lower in the gloved patients.
However, rates of skin toxicity—rash, peeling, induration, fibrosis, hyperpigmentation, or hand-foot syndrome—did not differ significantly between the two groups. One-third of the gloved patients had no skin changes, as did 44% of controls. Half of the gloved group experienced grade 1 skin toxicity, compared with 42% of controls. Grade 2 toxicity occurred in 17% of gloved patients, while grade 2/3 toxicity was noted in 14% of controls.
Dr. Nakayama said he and his coinvestigators have concluded that the frozen gloves, with their lack of side effects, are a useful advance in supportive care and merit inclusion in routine clinical practice. “We use this in the clinic now on a daily basis,” the surgeon added.
He contends, however, that the design can be improved upon, and has partnered with a Japanese manufacturer in developing a more efficient glove. They also plan to develop a frozen sock.
The frozen glove study was partially supported by Sanofi-Aventis.
ELSEVIER GLOBAL MEDICAL NEWS
SAN ANTONIO — Having breast cancer patients don a pair of flexible frozen gloves during infusion of docetaxel markedly reduced the chemotherapy-induced fingernail toxicity known as onycholysis in a phase II multicenter Japanese trial.
This nail finding confirms an earlier French report, but the Japanese team was unable to confirm another French finding that these same frozen gloves also prevent docetaxel (Taxotere)-induced skin toxicity (J. Clin. Oncol. 2005;23:4424–9), Dr. Takahiro Nakayama said at the San Antonio Breast Cancer Symposium.
The Elasto-Gel frozen gloves, which look like cobalt-blue bulbous mittens or boxing gloves, contain a glycerin-based gel that remains soft at low temperatures. The reusable gloves, made by Southwest Technologies Inc., of Kansas City, Mo., are charged up by being placed in a subzero freezer for several hours. They contain an inner disposable liner that prevents direct skin contact with the icy material.
Recently a group at Georges Pomidou European Hospital in Paris reported in a phase II case-control study that an Elasto-Gel frozen sock significantly reduced docetaxel-induced toenail onycholysis but not cutaneous toxicity (Cancer 2008;112:1625–31).
Dr. Nakayama, a breast surgeon at Osaka University, Japan, reported on a comparative trial involving 70 breast cancer patients who used the frozen gloves and 52 others who were not offered them. The gloves are worn for 90 minutes, beginning 15 minutes prior to a 60-minute infusion of docetaxel. Because the gloves tended to warm up beyond the critical 0-degree Celsius threshold too quickly, investigators had subjects swap them for a fresh pair midway through the treatment session.
The mechanism of benefit is thought to involve reduced blood flow to the nail, Dr. Nakayama said in an interview.
No onycholysis occurred in 41% of the gloved group compared with 8% of controls. Rates of grades 1–3 fingernail damage as defined in National Cancer Institute Common Toxicity Criteria were significantly lower in the gloved patients.
However, rates of skin toxicity—rash, peeling, induration, fibrosis, hyperpigmentation, or hand-foot syndrome—did not differ significantly between the two groups. One-third of the gloved patients had no skin changes, as did 44% of controls. Half of the gloved group experienced grade 1 skin toxicity, compared with 42% of controls. Grade 2 toxicity occurred in 17% of gloved patients, while grade 2/3 toxicity was noted in 14% of controls.
Dr. Nakayama said he and his coinvestigators have concluded that the frozen gloves, with their lack of side effects, are a useful advance in supportive care and merit inclusion in routine clinical practice. “We use this in the clinic now on a daily basis,” the surgeon added.
He contends, however, that the design can be improved upon, and has partnered with a Japanese manufacturer in developing a more efficient glove. They also plan to develop a frozen sock.
The frozen glove study was partially supported by Sanofi-Aventis.
ELSEVIER GLOBAL MEDICAL NEWS