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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
  3. Peak Incidence ages 50 to 70 years
  • Pathophysiology
  1. Subtype of Acral Lentiginous Melanoma
  • Characteristics
  1. Longitudinal nail band of brown-black streak (65% of patients on presentation)
    1. Proximal widening of band
    2. Irregular side borders
    3. Great toe most often involved
  2. May encompass entire nail
  3. Hutchinson's Nail Sign
    1. Melanoma affecting proximal nail fold skin
    2. Test Sensitivity: 42%
    3. Test Specificity: 96%
  • 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 or dystrophy (nail thickening or splitting)
  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. See Nail Longitudinal Band
  3. Subungual Hematoma
  4. Onychomycosis
  • Management
  1. Acral Lentiginous Melanoma is a very aggressive tumor with early metastasis even from small lesions
  • Prognosis
  1. Five year recurrence-free survival 53 to 80%
  • References
  1. Habif (2003) Clinical Dermatology, 4th ed.. Mosby, p. 773-813
  2. Rager (2005) Am Fam Physician 72:269-76 [PubMed]
  3. Nolan (2024) Am Fam Physician 110(6): 635-6 [PubMed]