Question

A 70 year old, African American patient comes to the clinic for his annual check-up. Upon examination, the nurse practitioner notices longitudinal brown bands on the nail bed. What is a must-not-miss in this patient?

a. Sickle cell anemia
b. Acral lentiginous melanoma
c. Melanonychia
d. Vitamin B12 deficiency

Answer 1

Longitudinal brown bands on a patient's nail beds can point to Acral lentiginous melanoma, a type of skin cancer that is critical to diagnose early. It is important for healthcare providers to differentiate this from other nail conditions and use the ABCDE mnemonic as a guide.

Step-by-step explanation:

The observation of longitudinal brown bands on the nail bed of a 70-year-old, African American patient particularly concerns the potential diagnosis of Acral lentiginous melanoma (ALM). This is a must-not-miss diagnosis as ALM is a serious form of skin cancer that typically appears on the palms, soles, and under the nails. It can often be mistaken for benign conditions, such as melanonychia, which is characterized by brown or black pigmentation of the nail unit. ALM is usually distinguished from other causes of nail pigmentation by the ABCDE mnemonic used to identify signs of early-stage melanoma: Asymmetry, Borders (irregular), Color (varied), Diameter, and Evolving. While sickle cell anemia, vitamin B12 deficiency, and melanonychia could be relevant to a patient's health, in the context of this finding and patient profile, failing to consider and appropriately investigate for ALM could have potentially grave consequences.