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Nail melanoma in children: differential diagnosis and management.

The clinical presentations of melanonychia depend on the number of the bands, color, edges, and width. Whatever is the trigger factor that has activated, or increased in number, the nail matrix melanocytes, the possibility of melanoma (malignant melanocytic hyperplasia) should always be ruled out. Hutchinson’s sign (extension of the pigmentation to the proximal or lateral nail folds) is an important indicator of nail melanoma and can help the clinician in performing the diagnosis even if it is not always present. In children nail melanoma is very rare, and melanonychia is generally due to nail matrix nevi (benign melanocytic hyperplasia). To our knowledge, until now only eight cases have been reported in the literature. We report two additional cases and discuss the histopathology, differential diagnosis, and management.