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Differential Diagnoses and Approach to Melanonychia The following are the differential diagnoses of melanonychia according to the presentation-[34] Nonmelanin pigmentation: The first and essential step is to establish the melanin or nonmelanin (e.g., exogenous, infections, hematoma) etiology Multiple nail involvementRacial, systemic causes, or frictional Single nail explained by skin and nail diseasesTrauma, inflammatory disorders, or tumors LM in childrenNail matrix nevus, Regular follow ups required LM in adultsHistopathology may be needed if doubtful

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The gene expression score showed a lower sensitivity than FISH in the unequivocal group (62% vs 93%) and marginally lower in the challenging group (52% vs 56%), while its specificity was similarly to FISH in both the unequivocal group (95% vs 100%) and in the challenging group (80% vs 83%)