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BOX 7-1 Lesion Characteristics in Nails That Should Raise a Red Flag Location: Single digit, thumb, or great toe nails Appearance: Fast growth, longitudinal melanonychia, band width more than 3-5 mm Hutchinsons Sign: Periungual pigmentation of skin Nail Dystrophy: Notch in free distal nail margin, surface irregularity, oozing, or bleeding lesion similar to ingrown nail Melanonychia striata Brown longitudinal stria (plural is striae) that occurs in the nail is called melanonychia striata

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Figure 1 Glycolytically derived lactate conversion is principally catalyzed by lactate dehydrogenase (LDH)a tetrameric enzyme composed of LDHA or LDHB subunits