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Understanding whether this represents a direct medication effect, an indirect consequence of therapy, or coincidental occurrence is essential for appropriate clinical management and informed decision-making

Two large caveats to this include patients with skin of color in whom melanonychia affecting multiple digits can be clinically different (darker, broader, etc.) than in Caucasians yet still benign and pediatric patients in whom melanonychia of a single digit due to a melanocytic lesion is usually benign even when it has worrisome features

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