Tinea unguium. on the left thumb of a 28-year-old man localized yellow-brown to black dyschromas of the distal nail plate, increasing for more than one year. onychodystrophy beginning distally. mycologically a mixed infection of Trichophyton rubrum and Aspergillus spp. was detected.
Nail hematoma: since exactly 6 weeks existing (trauma reminding), sharply forward limited blue-black discoloration of the big toe nail with discoloration of the epinychium; the sharp, here diagonally running dividing line without distal stripe-shaped discoloration of the nail matrix excludes a malignant melanoma!
DD: Melanoma malignes acrolentiginous: here: complicating onychomycosis with bleeding due to mold infestation; the inlet points proximally, a normally colored nail area; no Hutchinson phenomenon.
Melanoma, malignant, acrolentiginous. 13 x 10 mm large, extensive, black pigmented tumor of the subungual space and distension of the nail bed of the left big toe in a 61-year-old female patient. Advanced stage with nail destruction.
hematoma, nail hematoma. blue-blackish, sharply defined pigmentation (here of the big toe nail) due to a previous traumatic event. no distal stripy nail discoloration. the absence of distal stripy nail changes excludes the important differential diagnoses "subungual malignant melanoma" and "subungual melanocytic nevus".
Nail hematoma: sharply limited brownish discoloration of the nail; no streaky distal pigmentation of the nail (important differential diagnostic distinction to a malignant melanoma).
DD. acrolentiginous malignant melanoma: in this case nail hematoma . 6 weeks old (trauma recall), sharp blue-black discoloration of the big toe nail (marked by arrows and line) with discoloration of the epinychium (circle). arrow (right) indicates a streaky (still red) apparently fresh bleeding.
Nail hematoma: since exactly 6 weeks existing (trauma recallable), sharply forward limited blue-black discoloration of the big toe nail (marked by arrows and line) with discoloration of the epinychium (circle); arrow (right) indicates a streaky (still red) apparently fresher bleeding
Tinea unguium. dystrophic onychomycosis. colorful, not painful nail discoloration (yellow-blue-green) with nail thickening. part of the nail discoloration is apparently caused by bleeding. Tr. rubrum and molds (Alternaria spp.) have been detected culturally.
Striped black coloration of the big toe nail. The finding is unchanged since > 1 year. Here striped onychomycosis due to mold infestation of the nail. Diagnostic evidence is the normally colored proximal stripe above the nail dyschromia (see explanatory figure and reflected light microscopy).
Tinea unguium. distal onychomycosis with crumbly destruction of the nail matrix. aphlegmatic tinea of the toe skin with low lichenification and pityriasiform scaling.
Melanoma malignes subunguales: Nail with stripy and periungual brown markings (Hutchinson's sign) in acrolentiginous malignant melanoma under the nail plate and in the nail bed (see Levit's ABC Rule)
DD: acrolentiginous malignant melanoma: here: Melanonychia longitudinalis:stripy (melanotic) nail pigmentation caused by a (still benign) pigment nevus localized in the (not visible) nail matrix. The anterior cut edge of the nail plate is pigment-bearing (marked with an arrow). An initial malignant melanomacan be excluded histologically with certainty.
Hematoma, nail hematoma: growing nail hematoma . left initial situation, right 8 weeks later. note: the nail matrix shows no discoloration at the cutting edge (marked by arrows)!
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