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Longitudinal melanonychia
  1. Kamran Khan1,
  2. Arun A Mavanur2,3
  1. 1Department of General Surgery, Sinai Hospital of Baltimore, Baltimore, Maryland, USA
  2. 2Department of General Surgery, Johns Hopkins University, Baltimore, Maryland, USA
  3. 3Department of Surgical Oncology, Sinai Hospital of Baltimore, Baltimore, Maryland, USA
  1. Correspondence to Kamran Khan, kamkmd92{at}

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An otherwise healthy 13-year-old boy was noted to have a discolouration arising from the nail bed of the left thumb. The lesion exhibited brisk linear transformation since it was initially noticed 4 months prior. There was no family history of melanoma, and he was not taking any medications. Examination confirmed a symmetrically pigmented lesion in the subungual area of the left thumb, measuring 4 mm in width (figure 1). There was extension of the black pigmentation into the proximal nail fold (Hutchinson's sign), measuring 1 mm in length. A 6 mm punch was used to excise a circular segment of the nail, followed by a 4 mm punch biopsy of the subungual area (figure 2 …

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