Pigmented Nail Lesions: When to Observe, When to Biopsy, When to Widely Excise, and When to Amputate? Journal of Hand Surgery Melanonychia: moles and melanoma on the nail Dr. Podlipnik Nail changes can reveal major systemic disease, from cirrhosis and endocarditis to melanoma., Splinter hemorrhages + fever murmur should make you think of infective endocarditis., Single Pigmented Lesions of the Nail Unit: Clinical and Histopathologic Features