Subungual Nail Pigmentation and Malalignment of the Great Toe Nail in a Cancer Patient - A Diagnostic Challenge

Abstract

Subungual pigmentation may have a variety of underlying pathologies, but clinicians should consider malignancies such as subungual melanoma or metastasis, even if they are not common. A delayed diagnosis can dramatically worsen the prognosis. Therefore, histologic examination is highly recommended. We present a 75-year-old female cancer patient presenting with subungual blackish pigmentation of the great toe nail for several years suspicious of a subungual melanoma even by dermoscopy. Nail avulsion and histological investigations excluded melanoma. The final diagnosis was subungual hematoma with growth malalignment of the great toe nail.

Onychoscopy

“…Sentinel lymph node biopsy and subsequent follow-up should be considered (Haneke 2017;Duarte et al 2015). • Differential diagnosis: Subungual hematoma; fungal or bacterial nail infections; benign melanonychia caused by lentigo, nevi, and factors such as drugs, tobacco, pregnancy, and the physiological pigmentation found in darkskinned individuals; vascular diseases including vascular tumors and malformations; pyogenic granuloma; warts; and other melanocytic nail tumors (Haneke 2017;Wollina and Tchernev 2017;Deinlein et al 2016).…”