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Subungual Melanoma

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Subungual Melanoma, Ungual Melanoma, Hutchinson Nail Sign, Hutchinson's Nail Sign, Hutchinson's Melanotic Whitlow, Acral Lentiginous Melanoma

  • See Also
  1. Melanoma
  • Epidemiology
  1. Represents 2.5% of Melanomas
  2. Account for 50% of Melanomas in dark skinned patients
  • Pathophysiology
  1. Type of Acral Lentiginous Melanoma
  • Characteristics
  1. Longitudinal brown-black streak
  2. May encompass entire nail
  3. Hutchinson's Nail Sign
    1. Melanoma affecting proximal nail fold skin
  • Evaluation
  • Factors suggesting Melanoma
  1. Recent change (e.g. band wider or darker)
  2. Hutchinson's Nail Sign (see above)
  3. Individual nail involvement (especially first digit)
  4. Longitudinal band >3 mm wide (or widens at the proximal nail)
  5. Nail plate disruption
  6. New onset in caucasian or age >60 years
    1. May be normal variant in dark-skinned patients
    2. However, Melanoma also occurs in dark-skin patients
  • Differential Diagnosis
  1. See Melanonychia
  2. Nail Longitudinal Band
  • Management
  1. Acral Lentiginous Melanoma is a very aggressive tumor with early metastasis even from small lesions
  • Prognosis
  1. Five year survival is as low as 50%
  • References
  1. Habif (2003) Clinical Dermatology, 4th ed.. Mosby, p. 773-813
  2. Rager (2005) Am Fam Physician 72:269-76 [PubMed]