A Rare Case of Osteoinvasive Amelanotic Melanoma of the Nail Unit

Amelanotic melanoma is a rare subtype, which may be clinically difficult to diagnose due to lack of pigmentation and variable histopathological features. Osteoinvasion is another rare characteristic of melanoma. There are few reports in the literature of amelanotic melanoma of the nail unit (nail bed, matrix, and nail folds) with invasion of bone.

We present a case of a 73-year-old Caucasian male with a 13-month history of an ungual lesion on his right hallux. The lesion was initially treated as a chronic diabetic ulceration with failure to resolve with standard of care.

A heightened index of suspicion for a malignant process is necessary when standard of care fails to lead to improvement or resolution. In these instances, biopsy should be seriously considered.