Subungual Melanoma

Aka: Subungual Melanoma, Ungual Melanoma, Hutchinson Sign, Hutchinson's sign, Hutchinson's Melanotic Whitlow

1. See Also
   1. Melanoma
2. Epidemiology
   1. Represents 2.5% of Melanomas
   2. Account for 50% of Melanomas in dark skinned patients
3. Pathophysiology
   1. Type of acral lentiginous Melanoma
4. Characteristics
   1. Longitudinal brown-black streak
   2. May encompass entire nail
   3. Hutchinson's sign
      1. Melanoma affecting proximal nail fold
      2. May extend proximal to distal nail plate
5. Evaluation: Factors suggesting Melanoma
   1. Recent change (e.g. band wider or darker)
   2. Hutchinson's sign (see above)
   3. Individual nail involvement (especially first digit)
   4. Longitudinal band >3 mm wide
   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
6. Differential Diagnosis
   1. See Melanonychia
   2. Nail Longitudinal Band
7. Management
   1. Acral lentiginous Melanoma is a very aggressive tumor with early metastasis even from small lesions
8. References
   1. Habif (2003) Clinical Dermatology, 4th ed.. Mosby, p. 773-813
   2. Rager (2005) Am Fam Physician 72:269-76