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Representative clinical morphology, photomicrographs of H&E staining, and IHC staining for cyclin D1and PRAME of selected subungual benign melanocytic proliferation. One 7-year-old patient presenting with (A) 3.5 mm-wide melanonychia showed (B) melanocyte proliferation showing mild atypia without confluency or pagetoid spread (200x magnification, H&E). (C) While cyclin D1 IHC showed over 70% nuclear immunostaining (200x magnification), (D) PRAME IHC exhibited total negativity (200x magnification), (E) Sox-10 IHC (200x magnification)

Representative clinical morphology, photomicrographs of H&E staining, and IHC staining for cyclin D1and PRAME of selected subungual benign melanocytic proliferation. One 7-year-old patient presenting with (A) 3.5 mm-wide melanonychia showed (B) melanocyte proliferation showing mild atypia without confluency or pagetoid spread (200x magnification, H&E). (C) While cyclin D1 IHC showed over 70% nuclear immunostaining (200x magnification), (D) PRAME IHC exhibited total negativity (200x magnification), (E) Sox-10 IHC (200x magnification)

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Background Distinguishing benign lesion from early malignancy in melanocytic lesions of the nail unit still remains a diagnostic challenge, both clinically and histopathologically. While several immunohistochemistry (IHC) stainings have been suggested to help discriminate benign subungual melanocytic proliferation (SMP) and subungual melanoma in si...