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This means scans may appear normal even when significant disease is present

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High levels of these acute phase reactants correlate directly with the severity of disease activity and are predictive of a higher risk for subsequent structural and radiographic joint damage (Shmerling & Greisen, 2025)

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This is best regarded as a clinical sign when there is subungual melanoma confirmed histologycally, since a number of other conditions mimic Hutchinsons sign, including subungual haematoma, regressing nevoid melanosis in childhood, ethinic pigmentation, Laugier-Hunziker syndrome, Peutz-Jegher syndrome, radiation therapy, malnutrition, minocycline