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The most common cause in a study evaluating melanonychia of all morphologies was found to be subungual hemorrhage (29.1%), followed by nail matrix nevus (21.8%), trauma (14.5%), lentigo (11.6%), and race (8.0%).[9] While in a study evaluating only longitudinal melanonychia, racial melanonychia was seen in 68.6%, trauma in 8.5%, fungal in 7.1%, and mixed etiology in 4.5% of cases.[10] Benign melanocytic hyperplasia and nail apparatus malignancy contributed to 5.7% cases each

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PubMed, doi:10.1016/j.breast.2012.08.004