A Hidden Threat: Subungual Melanoma in Hand

Subungual melanoma, a relatively uncommon disease, has a worse prognosis than cutaneous melanoma in other sites. Both this life-threatening disease and its treatment cause cosmetic and functional impairment to the patient. The diagnosis is often delayed and resulting an advanced disease at presentation. The important clinical manifestation, diagnosis and latest treatments for subungual melanoma are reviewed. Electronic databases of Medline, PubMed, and the Cochrane library were searched with the key word “subungual melanoma”. A clinical scoring system is proposed by the authors to stratify patients to undergo biopsy, making earlier diagnosis of this disease possible. The latest trend of treatment involves wide local excision at a more distal level of the affected digit, in contrast to radical amputation of the digit in the past. Studies have shown that this does not decrease the survival nor increase local recurrence, but reduces the functional impairment for the patient. This review aims to summarise the approach to subungual melanoma for clinicians, so that they can recognise and diagnose this disease early and generate the best functional and cosmetic outcome for the patients.

The Impact of Subungual Osteochondroma Deformans on Severely Mycotic Toenails

Background: We examined 94 toenails exhibiting clinical signs of severe onychomycosis taking into account multiple contributing factors, not the least of which was Subungual Osteochondroma Deformans (SOD). We hypothesize that SOD plays a significant role in both the etiology and treatment of onychomycosis. Methods/Results: A retrospective post-treatment outcome analysis was performed comparing two groups of severely mycotic toenails. The first group of 25 fungal nails showed 54.31% improvement following treatment by both surgical nail avulsion and a 1064 YAG laser-based Nail Restoration algorithm. The second group of 69 fungal nails was not only treated using the same nail avulsion/laser-based algorithm but was also evaluated for SOD lesions which were surgically removed when present, resulting in 95.31% improvement. The overall incidence of SOD lesions in the second group of severely mycotic toenails was 73.91%. Conclusion: We submit that at 73.91% Subungual Osteochondroma Deformans has an under-reported and under-appreciated association with toenail fungus. Generally, we find that our success rates in treating severe toenail fungus using our laser-based Nail Restoration Protocols are much higher when SOD lesions are surgically removed.

Subungual exostosis of the finger in an 8-year-old girl

Introduction:Subungual exostosis(SE)is a relatively uncommon benign bone tumor that occurs in the distal phalanges of the toes or fingers.Case presentation:An 8-year-old girl presented for treatment of an acquired mass on the distal right index finger.The patient was preoperatively diagnosed with a benign bone tumor.Surgical resection of the distal right index finger mass was performed under general anesthesia,and histological examination of the resected tissue supported a diagnosis of SE of the right index finger.The surgical outcome was good,with no surgical site infection.Throughout 15 months of follow-up,the patient was asymptomatic with no recurrence.Conclusion:Surgical resection of a mass on the distal right index finger resulted in absence of recurrence during 15 months of follow-up.SE is a benign and uncommon lesion that is infrequently encountered by physicians.This infrequent occurrence may result in delays in diagnosis and treatment.Complete excision of the lesion and careful separation from underlying nail bed structures results in total resolution of the lesion,while providing the lowest risk of recurrence.

Subungual Exostosis Misdiagnosed as Subungual Wart

Introduction Subungual exostosis (SE) is a clinically rare benign bone tumor that develops underneath or beside the nail bed.SE can occur in any finger or toe,but it is most common at the distal phalanx of the hallux,accounting for about 70%-80% of cases.1 Patients generally have no subjective symptoms and often seek medical care for secondary infection or nail plate deformation.Because of its special location,SE is liable to be misdiagnosed as a subungual wart or other nail-related lesion.We herein report a case of SE in a patient,who was misdiagnosed as a subungual wart,in order to improve the knowledge of clinician to SE.

Squamous cell carcinoma of the nail bed: A case report

BACKGROUND Squamous cell carcinoma(SCC)of the nail bed is a poorly reported malignant subungual tumor.Because it presents with nonspecific symptoms and signs,it is frequently misdiagnosed by dermatologists or surgeons.A delay in diagnosis and/or wrong treatment might increase the possibility of disease progression.Thus,new perspectives are needed to assist dermatologists and surgeons with diagnosing and treating SCC.This rare case presented with a 2-year delay in the diagnosis of SCC teaches a valuable lesson.CASE SUMMARY A 62-year-old female presented with a non-healing subungual growth in the nail bed of the right middle finger for 2 years.The lesion was first medicated with iodine by the patient herself without any relief.Twenty months later,a dermatologist diagnosed the lesion as paronychia and treated it with nail avulsions repeatedly with no obvious alleviation.A lesionectomy confirmed the lesion was SCC.An extended excision of the tumor with amputation of the distal interphalangeal joint was subsequently performed.A biopsy of sentinel lymph nodes was negative.Due to the result of preoperative positron emission tomography-computed tomography scanning,sweeping of axillary lymph nodes was considered dispensable and was skipped.At the 2-year follow-up,the patient showed a quick recovery and no sign of recurrence.CONCLUSION Our successful diagnosis and treatment of the case highlights the need for additional attention to long-standing non-healing lesions of the nail bed and the necessity for discreet evaluation and customization of surgical interventions.

Longitudinal Melanonychia:How to Distinguish a Malignant Condition from a Benign One

Longitudinal melanonychia is not a rare clinical condition.It is mostly characterized by the presence of longitudinal,demarcated,and pigmented bands on the nail unit.The etiology is generally classified as melanocytic activation or melanocytic hyperplasia.Benign nail matrix nevi and malignant subungual melanoma are classified under the etiology of melanocytic hyperplasia.The manifestations of benign and malignant melanonychia present with similar clinical features,but the prognoses of these two conditions are quite different.Therefore,it is important to distinguish malignant melanoma from benign melanonychia.History,physical examination,dermoscopy,and biopsy are obtained or performed to help determine the diagnosis.Surgical excision is commonly performed in patients who are above 50 years of age,if the increase in width of the pigmented band is rapid or sudden,if the width of the band is over 5 mm,or if the border of the band becomes blurred.All excised specimens are subjected to pathological examination for final diagnosis.