This indicates whether chemotherapy or radiation therapy may be needed in addition to surgery. Teratomas commonly are classified using the Gonzalez-Crussi grading system: 0 or mature (benign); 1 or immature, probably benign; 2 or immature, possibly malignant (cancerous); and 3 or frankly malignant. If frankly malignant, the tumor is a cancer for which additional cancer staging applies.Teratomas are also classified by their content; a solid teratoma contains only tissues (perhaps including more complex structures); a cystic teratoma contains only pockets of fluid or semifluid such as cerebrospinal fluid, sebum, or fat; a mixed teratoma contains both solid and cystic parts. Cystic teratomas usually are grade 0 and, conversely, grade 0 teratomas usually are cystic. Grades 0, 1, and 2 pure teratomas have the potential to become malignant (grade 3), and malignant pure teratomas have the potential to metastasize. These rare forms of teratoma with malignant transformation may contain elements of somatic (not germ cell) malignancy such as leukemia, carcinoma, or sarcoma. A teratoma may contain elements of other germ cell tumors, in which case it is not a pure teratoma, but rather is a mixed germ cell tumor and is malignant. In infants and young children, these elements usually are endodermal sinus tumor, followed by choriocarcinoma. Finally, a teratoma can be pure and not malignant yet highly aggressive;  this is exemplified by growing teratoma syndrome, in which chemotherapy eliminates the malignant elements of a mixed tumor, leaving pure teratoma, which paradoxically begins to grow very rapidly.
They are also seen in patients with end-stage kidney disease on hemodialysis, Hodgkins disease, pellagra, and sickle cell anaemia.The lines remain visible as long as protein intake is inadequate or synthesis is impaired, and they should disappear upon return to normal function.In extreme conditions, Muehrckes lines may also arise from physical changes in peripheral circulation: one case study reported appearance of the lines in a healthy subject following ascent to 8,848 meters (29,029 ft) on Mount Everest. History
Muehrckes lines were described by American physician Robert C. Muehrcke (1921–2003) in 1956. In a study published in BMJ, he examined patients with known chronic hypoalbuminemia and healthy volunteers, finding that the appearance of multiple transverse white lines was a highly specific marker for low serum albumin (no subject with the sign had SA over 2.2 g/dL), was associated with severity of the underlying condition, and disappeared upon successful treatment (corticosteroids in nephrotic syndrome) or direct infusion of HSA. See also
Mees lines – a similar appearance, except the lines are in the nail and move as the nail grows
Half and half nails
Terrys nails
List of cutaneous conditions

References
Bibliography
Fawcett, Robert S.; Sean Linford; Daniel L. Stulberg (March 15, 2004). "Nail Abnormalities: Clues to Systemic Disease". American Family Physician. 69 (6): 1417–24. PMID 15053406. James, William; Berger, Timothy; Elston, Dirk (2005). Andrews Diseases of the Skin: Clinical Dermatology. (10th ed.). Saunders. ISBN 0-7216-2921-0. Muehrcke Lines of the Fingernails at eMedicine
Muehrckes Lines of the Fingernails on WebMD