Subungual malignant melanoma: difficulty in diagnosis

Area of Science:

• Dermatology
• Oncology
• Podiatry

Background:

• Subungual malignant melanoma is a rare but aggressive cancer.
• It often presents with non-specific symptoms, leading to diagnostic delays.
• Misdiagnosis as benign conditions like ingrowing toenails is common.

Purpose of the Study:

• To highlight the diagnostic challenges of subungual malignant melanoma.
• To emphasize the importance of considering melanoma in persistent nail bed abnormalities.
• To present clinical cases illustrating diagnostic difficulties.

Main Methods:

• Case report of a patient with bilateral subungual melanoma.
• Review of three additional clinical cases.
• Discussion of diagnostic criteria and differential diagnoses.

Main Results:

• The primary case involved a 61-year-old woman with bilateral great toe melanoma initially treated as ingrowing toenails for two years.
• Three other cases demonstrated varied presentations and diagnostic delays.
• Pigmentation of the nail bed or nail was a key feature.

Conclusions:

• Subungual malignant melanoma should be suspected in any persistent nail bed or nail abnormality.
• Early and accurate diagnosis is crucial for improved patient outcomes.
• Increased clinical awareness is needed to prevent delayed diagnosis.