A misdiagnosed nail bed melanoma

Area of Science:

• Dermatology
• Oncology

Background:

• Nail bed melanoma, also known as subungual melanoma, presents diagnostic challenges.
• Acral melanomas are rare and can have atypical presentations.
• Misdiagnosis of nail bed melanoma is common, often mistaken for benign conditions.

Observation:

• A 48-year-old woman presented with a dystrophic and pigmented lesion on her fourth fingernail.
• The lesion was initially misdiagnosed as onychomycosis (fungal nail infection).

Findings:

• Biopsy of the nail bed and nail matrix confirmed the diagnosis of nail bed melanoma.
• This case highlights an atypical presentation of acral melanoma.

Implications:

• Increased awareness of atypical nail bed melanoma presentations is needed among clinicians.
• Prompt biopsy is essential for accurate diagnosis of suspicious nail lesions.
• Timely diagnosis of subungual melanoma can improve patient outcomes.