Melanoma is a life threatening cancer of the skin pigment cells, namely, melanocytes. It is a potentially treatable form of cancer if diagnosed and managed at an early stage. However, melanoma of the nail unit can be difficult to recognize and may be misdiagnosed as fungus. Consequently, this can lead to delays in diagnosis and appropriate management. Melanoma of the nail unit carries a particularly poor prognosis when compared to melanoma arising at other body sites.
A 74-year-old hispanic female presented for evaluation of asymptomatic pigmentation to the nail of her right second finger. Per the patient, the discoloration began as a narrow longitudinal band slowly widening over the last four years.
On exam, the entire nail was darkly pigmented with extension of pigmentation to the free edge of the nail and onto the distal finger tip skin with distal onycholysis. Punch biopsy of the nail matrix confirmed a diagnosis of melanoma in-situ. The patient was referred to a hand surgeon for removal of residual melanoma. Melanoma of the nail unit is rare, accounting for only about 1% melanoma in white-skinned individuals. Due to delays in diagnosis, this type of melanoma has a poor prognosis.
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