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