Non-melanoma Hutchinson's sign: A reappraisal of this important, remarkable melanoma simulant

Abstract

Background

More than 20 years ago our reappraisal of the Hutchinson Sign (HS) gave birth to the concept of the Pseudo-Hutchinson sign.

Objectives

We have found it interesting to emphasize some important histologic points and to expand the list of the numerous HS simulants.

Methods

We have examined the cutaneous samples taken from the pigmented skin of patients in association with nail matrix biopsy. We have also extended the long list of non-melanoma HS.

Results

Histologically HS may present only as an epidermal pigmentation, depending on the area sampled. Occasionally, there may be a sparse junctional melanocytic proliferation which does not demonstrate cytologic atypia due to an underlying melanocytic nevus of the nail matrix. However, early HS can show a melanoma in situ, with a HS at the proximal nail fold (PNF) and confluent atypical melanocytes in the nail matrix. Finally, involvement of the proximal nail fold, nail matrix and nail bed containing atypical melanocytes in irregular array may be seen.

Conclusion

The mere presence of periungual pigmentation is neither clinically nor histologically pathognomonic of subungual melanoma and justifies the usefulness of this work stressing the non-melanoma HS.

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