Melanonychia, or melanin-derived brown-to-black nail pigmentation, is a diagnostic challenge for clinicians. The most serious\r\ndisease of the nail unit, melanoma, primarily presents with melanonychia. However, melanonychia most often occurs as a result of\r\nbenign etiologies such as nail matrix melanocytic activation, nail matrix melanocytic hyperplasia, and nail invasion by melaninproducing\r\npathogens. Regrettably, patients with nail apparatus melanoma are often initially misdiagnosed, and due to diagnostic\r\ndelays of an average of 2 years, melanoma of the nail unit carries a poor prognosis. Having a thorough knowledge of the various\r\ncauses of melanonychia and using a systematic approach when evaluating brown-to-black nail pigmentation may help prevent\r\nmisdiagnosis and thereby improve prognosis.
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