Melanonychia Management and Characteristics

Clinical Presentation and Etiology

Medications, particularly taxanes and other chemotherapeutic agents, can cause melanonychia 1

Subungual hematoma (blood collection under the nail) should be differentiated from melanonychia 2
Onychomycosis (fungal nail infection) is a differential diagnosis for melanonychia 3
Onycholysis (separation of nail plate from nail bed) may appear similar to melanonychia 1

Daily application of topical emollients on periungual folds, matrix, and nail plate can help manage medication-induced melanonychia 1
Use of protective nail lacquers to limit water loss from the nail plate is recommended for medication-induced melanonychia 1
Avoiding nail trauma, excessive water exposure, and harsh chemicals can help prevent medication-induced melanonychia 4
Frozen gloves (10-30°C for 90 minutes) have shown significant reduction in nail changes during taxane therapy 1
Taxane therapy can cause a constellation of nail changes including onycholysis and melanonychia 1

In adult patients who develop a new, unexplained melanonychia, postponing a nail matrix biopsy is associated with a frequent delay in the diagnosis of subungual melanoma because the lesion is often initially misinterpreted as benign. 5