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Updated: Jan 25, 2026

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Subungual Melanoma.

Travis W Littleton1, Peter M Murray2, Mark E Baratz1

  • 1Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15237, USA.

The Orthopedic Clinics of North America
|May 16, 2019
PubMed
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Subungual melanoma, a rare nail cancer, often presents as longitudinal melanonychia. Early biopsy guided by the "ABCDEF" criteria is crucial for timely diagnosis and treatment of this challenging condition.

Area of Science:

  • Dermatology
  • Oncology
  • Surgical Pathology

Background:

  • Subungual melanoma is a rare malignancy with diagnostic challenges due to nail unit anatomy.
  • Early clinical presentation often mimics benign conditions like longitudinal melanonychia.
  • Delayed diagnosis significantly impacts patient prognosis.

Purpose of the Study:

  • To highlight the diagnostic challenges of subungual melanoma.
  • To emphasize the importance of early recognition and biopsy for longitudinal melanonychia.
  • To provide a screening tool for nail bed lesions.

Main Methods:

  • Review of clinical presentations and diagnostic pathways for subungual melanoma.
  • Application of the "ABCDEF" mnemonic for screening nail bed lesions.
Keywords:
Hutchinson signLongitudinal melanonychiaMalignant melanomaMelanocytesNail matrixPeriungualSubungual melanoma

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  • Discussion of surgical considerations for nail unit biopsies.

    • Main Results:

    • Longitudinal melanonychia is a common initial sign of subungual melanoma.
    • The "ABCDEF" guide offers a structured approach to lesion assessment.
    • Expertise in nail unit pathoanatomy is vital for accurate biopsy.

    Conclusions:

    • High clinical suspicion and a low threshold for biopsy are essential for managing patients with longitudinal melanonychia.
    • The "ABCDEF" guide aids in the screening of potentially malignant nail bed lesions.
    • Surgical expertise is paramount for effective subungual melanoma diagnosis and management.