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Melanonychia striata is due to increased activity of melanocytes or melanocytic hyperplasia in the nail matrix with subsequently increased melanin deposition in the nail plate. The most common cause of melanonychia striata associated with melanocytic activation is ethnic melanonychia which occurs in dark\u2010skinned individuals. Other causes of melanonychia striata related to melanocytic activation include pregnancy, chronic local trauma, infections, medications, dermatological disorders, endocrine disorders, alkaptonuria, hemochromatosis, porphyria, graft\u2010vs\u2010host disease, Peutz\u2010Jeghers syndrome, and Laugier\u2010Hunziker syndrome. Causes of melanonychia striata associated with melanocytic hyperplasia include nail matrix melanocytic nevus, nail lentigo, and nail apparatus\/subungual <jats:italic>in\u00a0situ<\/jats:italic> and invasive melanoma. In most cases, melanonychia striata is a benign condition, especially in children. Consequently, most investigators advocate a wait\u2010and\u2010see approach. Nail apparatus\/subungual melanoma should be suspected if there is an abrupt onset after middle age, personal or family history of melanoma, rapid growth, darkening of a melanonychia band, pigment variegation, blurry lateral borders, irregular elevation of the surface, a bandwidth &gt;3\u00a0mm, proximal widening, associated nail plate dystrophy, single rather than multiple digit involvement, and periungual spread of pigmentation onto the adjacent cuticle and\/or proximal and\/or lateral nail folds (Hutchinson sign). Prolonged follow\u2010up is mandatory for early detection of possible malignant changes.<\/jats:p>","DOI":"10.1111\/ijd.14464","type":"journal-article","created":{"date-parts":[[2019,4,22]],"date-time":"2019-04-22T06:41:49Z","timestamp":1555915309000},"page":"1239-1245","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":47,"title":["Melanonychia striata: clarifying behind the Black Curtain. A review on clinical evaluation and management of the 21st century"],"prefix":"10.1111","volume":"58","author":[{"given":"Alexander K. 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