The observation of a black-brown pigmentation of the nail is often alarming for the patient and for the clinician, as they are aware that it can be a possible clinical manifestation of melanoma of the nail apparatus. Luckily, however, nail melanoma is a much less frequent cause of brown-black nail color than other melanocytic and nonmelanocytic pigmentations, which include subungual hematoma, exogenous pigmentations, and melanonychia due to benign conditions. A correct clinical history and careful examination help the clinician to distinguish the different conditions and to decide the correct management of melanonychia both in children and in adults.
Key points
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A brown pigmentation of the nail is not necessarily due to melanin.
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Dermoscopy should be used routinely when dealing with nail pigmentations.
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Clinical history, number of nails involved, and associated nail and internal diseases are important parameters to consider when evaluating melanic nail pigmentation.
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Childhood longitudinal melanonychia of a single digit is most commonly a nevus.
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Adult-onset melanonychia of a single digit should be carefully evaluated and often needs a bioptic examination.
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