Atypical Presentation of Subungal Melanoma

Hwang,  Seung Hwan; Bahk,  Sujin; Eo,  SuRak

doi:2017.22.1.68

Arch Hand Microsurg > Volume 22(1); 2017 > Article

Case Report

Journal of the Korean Society for Surgery of the Hand 2017;22(1):68-72.
Published online March 31, 2017.
DOI: https://doi.org/10.12790/jkssh.2017.22.1.68

Atypical Presentation of Subungal Melanoma

Seung Hwan Hwang, Sujin Bahk, SuRak Eo

Department of Plastic and Reconstructive Surgery, DongGuk University Graduate School of Medicine, Seoul, Korea. sreodoc@gmail.com

Received: 6 October 2016 • Revised: 17 January 2017 • Accepted: 27 January 2017

Abstract

Malignant melanomas sometimes present with nail or periungual pigmentation, as a subungual melanoma. This pigmentation also occurs in nonmelanoma skin disorders. Therefore, biopsy is mandatory for the absolute diagnosis. We present an atypical presentation of subungual melanoma in an 81-year-old female patient with no specific periungual pigmentation. She suffered from a crushing injury in her right thumb 2 years ago and had undergone repetitive stump plasty at a local clinic. Recently, she felt intermittent pain at the thumb tip. During the revisional stump plasty, we unexpectedly noted a spread out of dark colored soft tissues the distal phalanx. Pathological examination revealed subungual malignant melanoma. This unusual form of melanoma has a predilection for an acral location, particularly the paronychial region. Even when small pigments are found on the periungual area, careful examination and identification of a component of melanoma is necessary in order to not miss any malignant finger lesion.