J Korean Soc Surg Hand.  2017 Mar;22(1):68-72. 10.12790/jkssh.2017.22.1.68.

Atypical Presentation of Subungal Melanoma

• Hwang SH
• Bahk S
• Eo S

• KMID: 2375470
• DOI: http://doi.org/10.12790/jkssh.2017.22.1.68

Abstract

Malignant melanomas sometimes present with nail or periungual pigmentation, as a subungual melanoma. This pigmentation also occurs in nonmelanoma skin disorders. Therefore, biopsy is mandatory for the absolute diagnosis. We present an atypical presentation of subungual melanoma in an 81-year-old female patient with no specific periungual pigmentation. She suffered from a crushing injury in her right thumb 2 years ago and had undergone repetitive stump plasty at a local clinic. Recently, she felt intermittent pain at the thumb tip. During the revisional stump plasty, we unexpectedly noted a spread out of dark colored soft tissues the distal phalanx. Pathological examination revealed subungual malignant melanoma. This unusual form of melanoma has a predilection for an acral location, particularly the paronychial region. Even when small pigments are found on the periungual area, careful examination and identification of a component of melanoma is necessary in order to not miss any malignant finger lesion.

Keyword

Fingers; Melanoma; Atypical forms

MeSH Terms

Aged, 80 and over
Biopsy
Diagnosis
Female
Fingers
Humans
Melanoma*
Pigmentation
Skin
Thumb

Figure

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  Fig. 1 (A) Bilateral fingertip nail remnants on the eponychium. (B) X-ray images of the first visit. She had been underwent stump plasty with nail extraction.

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  Fig. 2 During the exploration, we happened to dark, black color tinged soft tissues and bone which were spread out like dye-tinged tissues.

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  Fig. 3 (A) Surgical amputation was performed at the metacarpophalangeal (MCP) joint level. (B) Postoperative X-ray, posteroanterior view showing the final result.

Reference

1. Imakado S, Sato H, Hamada K. Two cases of subungual melanoma in situ. J Dermatol. 2008; 35:754–758.

2. Linares MD, Hardisson D, Perna C. Subungual malignant melanoma of the hand: unusual clinical presentation: case report. Scand J Plast Reconstr Surg Hand Surg. 1998; 32:347–350.

3. Yang Z, Xie L, Huang Y, et al. Clinical features of malignant melanoma of the finger and therapeutic efficacies of different treatments. Oncol Lett. 2011; 2:811–815.

4. Kottschade LA, Grotz TE, Dronca RS, et al. Rare presentations of primary melanoma and special populations: a systematic review. Am J Clin Oncol. 2014; 37:635–641.

5. Baran R, Kechijian P. Hutchinson's sign: a reappraisal. J Am Acad Dermatol. 1996; 34:87–90.

6. Tang CY, Fung BK, Lung CP. A hidden threat: subungual melanoma in hand. Surg Sci. 2012; 3:78–83.

7. Cohen T, Busam KJ, Patel A, Brady MS. Subungual melanoma: management considerations. Am J Surg. 2008; 195:244–248.

8. O’Leary JA, Berend KR, Johnson JL, Levin LS, Seigler HF. Subungual melanoma: a review of 93 cases with identification of prognostic variables. Clin Orthop Relat Res. 2000; (378):206–212.

9. Warso M, Gray T, Gonzalez M. Melanoma of the hand. J Hand Surg Am. 1997; 22:354–360.

10. Sinno S, Wilson S, Billig J, Shapiro R, Choi M. Primary melanoma of the hand: an algorithmic approach to surgical management. J Plast Surg Hand Surg. 2015; 49:339–345.