Subungual Melanoma

Subungual Melanoma is a medical condition characterized by dark brown or purple discoloration of the nail unit, leading to breakage or thinning. Read and know all about this disease, including its symptoms, causes, diagnosis, treatment and more.

Subungual Melanoma Definition

It refers to an uncommon clinical entity, which typically occurs on the big toe or thumb under the nail. This melanoma originating from the nail matrix is a type of benign cancer (fatal in few cases) and is often presented as a dark pigmented streak in the nail.

Subungual Melanoma Incidence

The reported incidence of this rare medical condition is between 1% to 4% of all melanoma cases founded in males and females. It is one of the common types of melanoma diagnosed in deeply pigmented individuals, especially among the Asians and African-American descents. Extremely rare in children, patients suffering from this disorder are generally aged between sixty and seventy.

Subungual Melanoma Appearance

How does Subungual Melanoma look like?

This nail disorder often commences as a pigment band, which is visible to the naked eye on the nail plate. From weeks to months, the pigment stripe:

  • Changes into light brown, purple or black color
  • Spreads out and includes the most adjacent nail fold (Hutchinson sign)
  • Gets wider on the cuticle

Subungual Melanoma look like

Although in most of the cases, this disease is amelanotic (not pigmented) in nature. Since the early sign of this disorder is a black or brown pigmentation in the nail bed, the development is often mistaken as Subungual Hematoma (bruise).

Subungual Melanoma Causes

As per doctors and health care providers, three different kinds of cancer can give rise to this nail disorder, which include:

  • Nodular melanoma
  • Acral lentiginous melanoma – the most common type of cancer that gives rise to this medical condition.
  • Desmoplastic melanoma

In rare cases, physical trauma to the nail can also lead to this benign disorder.

Subungual Melanoma Diagnosis

Diagnosis begins the moment a changing pigment band in a single nail is noticed. The diagnosis of this type of this melanoma is confirmed by biopsy of the nail bed and nail matrix. Since it is a difficult diagnosis, examination by an expert dermatopathologists is highly recommended.

Subungual Melanoma Differential Diagnosis

The differential diagnosis of this form of melanoma includes:

  • subungual hematoma
  • melanonychia striata
  • chronic bacterial fungal infection

Subungual Melanoma Symptoms

Around half of all suffers wear dark color nail polish, which makes it hard to spot the disease and hence is often overlooked. Furthermore, this type of nail disorder often leads to the conception of a damage/trauma to the nail from a recent injury. The primary symptoms of this medical condition start with a dark line underneath the nail. In addition to this, other symptoms may include:

  • small bump under the nail without any color
  • dark purple, black or brown spot on the nail
  • blood from the nails but no pain

Subungual Melanoma Treatment

Sufferers of this disorder are generally recommended to surgery however, it depends on the stage and severity of the disease. Local excision is prescribed by a physician if the melanoma has crossed a depth of one millimeter. In case of a wider melanoma which has spread across the lymph node, excision along with a biopsy is the only option. In rare cases, when the surgery is not effective, doctors recommend chemotherapy to patients, as the last weapon to kill the cancer cells in the nails.

Subungual Melanoma Prognosis

The outcome is poor for this disease, often due to late diagnosis. The most important aspect, which influences the prognosis, is the presence of lymph node involvement, stressing the importance of complete examination for such patients.

Subungual Melanoma Pictures

Check these images to know more about the condition.

Picture of Subungual Melanoma Pictures of Subungual Melanoma Photos of Subungual Melanoma Images of Subungual Melanoma


A single pigmented streak, especially in dark skinned individuals is of great concern. Consult a dermatologist or your physician the moment you witness a dark spot (brown or black) in your finger or toe nail to avoid the risk of a fatal cancer.


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