Hutchinson's sign

Hutchinson's sign is a clinical sign which indicates the presence of melanoma in the nail matrix. It is characterized by the pigmentation of the proximal and lateral nail folds. This sign is named after Sir Jonathan Hutchinson, a British surgeon and pathologist.

Overview

Hutchinson's sign is a crucial diagnostic tool in the field of dermatology. It is often associated with subungual melanoma, a type of skin cancer that occurs under the nail. The sign is characterized by a brown or black band on the nail, which extends to the cuticle and the skin around the nail. This pigmentation is caused by the proliferation of melanocytes, the cells responsible for producing melanin, the pigment that gives color to our skin, hair, and eyes.

Clinical Significance

The presence of Hutchinson's sign is a strong indicator of subungual melanoma, although it can also be seen in benign conditions such as chronic paronychia, onychomycosis, and trauma. Therefore, a thorough examination and further diagnostic tests are necessary to confirm the diagnosis.

Diagnosis

The diagnosis of subungual melanoma is often delayed due to its rare occurrence and the lack of awareness among patients and healthcare providers. The presence of Hutchinson's sign should prompt a biopsy to rule out melanoma. Dermoscopy, a non-invasive diagnostic tool, can also be used to visualize the pigmented bands and other features of the nail unit.

Treatment

The treatment of subungual melanoma involves surgical removal of the tumor. The extent of the surgery depends on the stage of the disease. In early stages, a wide local excision may be sufficient, while in advanced stages, amputation of the digit may be necessary.

See Also

• Melanoma
• Subungual melanoma
• Dermoscopy