A Hidden Threat: Subungual Melanoma in Hand

Tang, Chris Yuk Kwan; Fung, Boris; Lung, C. P.

doi:10.4236/ss.2012.32014

Cited by 4 publications

(2 citation statements)

References 36 publications

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“…While cutaneous melanoma has been found to be more common in Caucasians, melanoma in unusual sites such as hands and feet is thought to occur disproportionately more often in dark skinned race 8 . Subungual melanoma has the peak incidence in the 5th to 7th decades and known to be occurred most frequently in the thumb (34%) and the 3rd finger (14%) 6,8 . Despite the apparent increase in attention to subungual melanoma, little progress has been made in the characterization of the diagnosis and prognosis.…”

Section: Discussionmentioning

confidence: 99%

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Atypical Presentation of Subungal Melanoma

Hwang

Bahk

2017

J Korean Soc Surg Hand

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This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/bync/ 3.0/) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.Malignant melanomas sometimes present with nail or periungual pigmentation, as a subungual melanoma. This pigmentation also occurs in nonmelanoma skin disorders. Therefore, biopsy is mandatory for the absolute diagnosis. We present an atypical presentation of subungual melanoma in an 81-year-old female patient with no specific periungual pigmentation. She suffered from a crushing injury in her right thumb 2 years ago and had undergone repetitive stump plasty at a local clinic. Recently, she felt intermittent pain at the thumb tip. During the revisional stump plasty, we unexpectedly noted a spread out of dark colored soft tissues the distal phalanx. Pathological examination revealed subungual malignant melanoma. This unusual form of melanoma has a predilection for an acral location, particularly the paronychial region. Even when small pigments are found on the periungual area, careful examination and identification of a component of melanoma is necessary in order to not miss any malignant finger lesion.

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Section: Discussionmentioning

confidence: 99%

“…Some suggested an association with a history of nail trauma in addition to sun exposure 4 . Although, there has never been conclusive evidence that trauma is a causative factor, 29%-55% of patients report the relationship between direct trauma and the onset of subungual melanoma in recent studies 6 .…”

Section: Discussionmentioning

confidence: 99%

Atypical Presentation of Subungal Melanoma

Hwang

Bahk

2017

J Korean Soc Surg Hand

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Mimickers

Fowler¹,

Tosti²

2017

Onychomycosis

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Clinical and molecular features of subungual melanomas are site-specific and distinct from acral melanomas

Holman¹,

Gulick²,

Amato³

et al. 2020

Melanoma Research

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Subungual melanomas (SUM) arise beneath the nails of the hands and feet, and account for 0.7–3.5% of all malignant melanomas. Most studies include SUM in the category of acral melanoma, but understanding the specific features of SUM is critical for improving patient care. In this study, we performed a site-specific comparison of the clinical and molecular features between 54 cases of SUM and 78 cases of nonsubungual acral melanoma. Compared to patients with acral melanoma, patients with SUM were younger at diagnosis, had a higher prevalence of primary melanomas on the hand, and had more frequent reports of previous trauma at the tumor site. SUM was deeper than acral melanoma at diagnosis, which correlated with an increased frequency of metastases. Analysis of common melanoma driver genes revealed KIT and KRAS mutations were predominantly found in SUM, whereas BRAF and NRAS mutations occurred almost exclusively in acral melanoma. We also discovered molecular differences in the cell cycle pathway, where CDK4/CCND1 amplifications were more frequent in SUM and CDKN2A/B loss occurred mostly in acral melanoma, and in the PI3K/mTOR pathway, where RICTOR amplification and TSC1 K587R mutations were exclusively in SUM and PTEN loss and AKT1 mutations were exclusively in acral melanoma. Comparison of hand versus foot tumors revealed more frequent ulceration of SUM foot tumors, which correlated with more distal metastases and poorer overall survival. In summary, we find SUM are both clinically and molecularly distinct from acral melanoma, and our data suggest KIT, CDK4/6, and mTOR inhibitors may be particularly relevant and effective treatments for patients with SUM.

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A Hidden Threat: Subungual Melanoma in Hand

Cited by 4 publications

References 36 publications

Atypical Presentation of Subungal Melanoma

Atypical Presentation of Subungal Melanoma

Mimickers

Clinical and molecular features of subungual melanomas are site-specific and distinct from acral melanomas

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