II. Epidemiology
III. Pathophysiology
- Subtype of Acral Lentiginous Melanoma
IV. Characteristics
- Longitudinal nail band of brown-black streak (65% of patients on presentation)
- Proximal widening of band
- Irregular side borders
- Great toe most often involved
- May encompass entire nail
- Hutchinson's Nail Sign
- Melanoma affecting proximal nail fold skin
- Test Sensitivity: 42%
- Test Specificity: 96%
V. Evaluation: Factors suggesting Melanoma
- Recent change (e.g. band wider or darker)
- Hutchinson's Nail Sign (see above)
- Individual nail involvement (especially first digit)
- Longitudinal band >3 mm wide (or widens at the proximal nail)
- Nail plate disruption or dystrophy (nail thickening or splitting)
- New onset in caucasian or age >60 years
- May be normal variant in dark-skinned patients
- However, Melanoma also occurs in dark-skin patients
VI. Differential Diagnosis
VII. Management
- Acral Lentiginous Melanoma is a very aggressive tumor with early metastasis even from small lesions
VIII. Prognosis
- Five year recurrence-free survival 53 to 80%
IX. References
- Habif (2003) Clinical Dermatology, 4th ed.. Mosby, p. 773-813
- Rager (2005) Am Fam Physician 72:269-76 [PubMed]
- Nolan (2024) Am Fam Physician 110(6): 635-6 [PubMed]