Most subungual melanomas
occur on the thumb or big toe and can be identified by a dark line running down the length of the nail, perpendicular to the cuticle.
For subungual melanoma, amputation at the metatarsophalangeal or metacarpophalangeal joint is the optimal treatment.
(3,4) When combined with operative excision, isolated limb perfusion with melphalan is effective in patients with plantar and subungual melanoma; when performed in centres of expertise, there is minimal morbidity.
Today, subungual melanoma is often neglected by patients and frequently misdiagnosed by physicians.
(1) Because of its poor prognosis, often related to delay in diagnosis, maintain a high index of suspicion for subungual melanoma in the proper setting and a sound understanding of which lesions need to be biopsied.
Despite these similarities, there are some key clues that distinguish melanonychia striata from subungual melanoma, said Dr.
Nagi warned that subungual melanoma is often asymptomatic and that up to 25% of cases can be amelanotic, so it is easily mistaken for pyogenic granuloma, chronic granulation tissue, or mycobacterial infection with nail dystrophy
makes up 15%-20% of all melanomas in African Americans and 2%-3% of all melanomas in whites.
Each streak should be examined, however, because darker skinned individuals have a higher risk of subungual melanoma
than light-skinned patients.
-- Subungual melanomas
seem to travel under the radar screen of many physicians, and are diagnosed relatively late in the course of discase partly because of their relatively low incidence and an appearance that can commonly be mistaken for other conditions, Dr.
Yet subungual melanoma
can be a challenge to diagnose in older African Americans, who commonly have benign linear nail streaks that may be brown or even dark brown.
Levit created a modified ABCDEF rule for the clinical detection of subungual melanomas