What are the other Names for this Condition? (Also known as/Synonyms)

• Melanotic Macules of the Nail Apparatus
• Melanotic Macules of the Nail Unit
• Ungual Melanosis

What is Ungual Melanotic Macules? (Definition/Background Information)

• Melanotic macules are dark spots that may be observed on the skin, mucus membranes of the mouth, genitalia, and in the nails. Melanotic macules are benign and no malignant transformation to a melanoma has been recorded
• A macule indicates the presence of a flat, distinct, discolored area of skin less than 1 cm wide. A macule usually does not involve any change in the thickness or texture of the affected skin
• Ungual Melanotic Macules involves the nails (the nail bed and nail matrix) of the fingers, in most cases. It is present in both children and adults with a preference for dark-skinned individuals. This condition is also referred to as Melanotic Macules of the Nail Unit
• The presence of numerous melanotic macules on the body may be associated with a variety of syndromes including Carney complex, Peutz-Jeghers syndrome, and LEOPARD syndrome. In such cases, the cause of the condition is genetically-influenced
• In most cases, Ungual Melanotic Macules are asymptomatic and do not present any significant signs and symptoms. No complications are typically associated with these lesions; although in some cases, the macules may be confused for melanoma in situ (an early stage of melanoma)
• In a majority, no treatment of Ungual Melanotic Macules may be necessary, and the healthcare provider may undertake a ‘wait and watch’ approach. The prognosis is excellent with appropriate careful follow-up. Any noted changes must then be evaluated and acted on

Who gets Ungual Melanotic Macules? (Age and Sex Distribution)

• Ungual Melanotic Macules can be seen in children and adults, though many cases are seen in young individuals
• Both male and female genders are affected
• All races and ethnic groups may be observed with these skin spots, although there is a strong predilection for dark-skinned individuals
• Also, for some unknown reasons, the incidence of Melanotic Macules of the Nail Unit is higher among the Japanese population

What are the Risk Factors for Ungual Melanotic Macules? (Predisposing Factors)

Presently, there are no risk factors identified for solitary Ungual Melanotic Macule. In the case of multiple melanotic macules, the following rare genetic conditions may be involved:

• Laugier-Hunziker syndrome
• Carney complex
• Lentigines, Electrocardiographic conduction abnormalities, Ocular hypertelorism, Pulmonic stenosis, Abnormal genitalia, Retardation of growth, Deafness (LEOPARD) syndrome
• Peutz-Jeghers syndrome
• Lentigines, Atrial Myxoma, and Blue nevi (LAMB) syndrome
• Nevi, Atrial myxoma, Myxoid neurofibroma, and Ephelides (NAME) syndrome

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Ungual Melanotic Macules? (Etiology)

The exact cause of Ungual Melanotic Macules is not well-understood. 

• When numerous macules are observed, they may be found in association with certain genetic conditions or syndromes
• When these macules occur in isolation, they are usually sporadic and no associated conditions are observed

The skin condition is not infectious and does not spread from one individual to another through contact.

What are the Signs and Symptoms of Ungual Melanotic Macules?

The clinical signs and symptoms of Ungual Melanotic Macules include the following:

• The presence of longitudinal streaks on the nails (called longitudinal melanonychia)
• Usually the fingernails are involved, though the toenails may also be affected
• They width of the bands are not more than 3 mm in size
• The color of the macules may be uniform or non-uniform
• The macules may be single or multiple; the borders are usually irregular
• When Laugier-Hunziker syndrome is present, the melanotic macules may involve the oral cavity too (including the lips)
• The macules may be present unchanged for many years. Some are indistinguishable from a melanoma (a skin cancer type)

How is Ungual Melanotic Macules Diagnosed?

The diagnosis of Ungual Melanotic Macules may involve the following procedures:

• The diagnosis is usually made by a complete physical examination and evaluation of medical history and family history
• Dermoscopy: Dermoscopy is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
• Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation
• Skin biopsy: A skin biopsy is performed and sent to a laboratory for a pathological examination, who examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis. A skin biopsy is performed to rule out other similar conditions
• Biopsies done in the nail unit present special challenges

Note: A skin biopsy is not usually necessary, but may be performed if the healthcare provider suspects a possible malignancy such as a melanoma in situ.

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Ungual Melanotic Macules?

The complications of Ungual Melanotic Macules may include the following:

• The appearance of the pigmented macules may induce a fear of melanoma (which is a type of skin cancer)
• Complications that arise from an underlying genetic condition/syndrome

How is Ungual Melanotic Macules Treated?

The treatment of Ungual Melanotic Macules may include the following:

• The healthcare provider may choose to regularly observe the benign lesions; a “wait and watch” approach may be followed, once a diagnosis of a melanotic macule is established. In such cases, no treatment is generally required
• If required, a surgical excision and complete removal of the macule, primarily to address cosmetic issues
• Treatment of the underlying associated genetic disorder, if any
• Follow-up care with regular screening and check-ups are encouraged

How can Ungual Melanotic Macules be Prevented?

There is currently no effective means of prevention of Ungual Melanotic Macules, because the cause of this condition is unknown.

What is the Prognosis of Ungual Melanotic Macules? (Outcomes/Resolutions)

• The prognosis of Ungual Melanotic Macules is typically excellent with adequate treatment. No malignant transformations of these macules have been recorded
• If these lesions are associated with any genetic disorders, then the overall prognosis depends upon the severity of the signs and symptoms of the disorder

Additional and Relevant Useful Information for Ungual Melanotic Macules:

• Carney complex comprises a combination of medical conditions that includes multiple tumors, such as myxomas, schwannomas, endocrine disorders, and pigmented skin conditions

Please read more on Carney complex by visiting the following link below:

http://www.dovemed.com/diseases-conditions/carney-complex-cnc/