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Subungual melanomaC43.L
Synonym(s)
Acral lentiginous melanoma; Nail melanoma; Subungual malignant melanoma; Subungual melanoma
DefinitionThis section has been translated automatically.
Rare (1-2% of all malignant melanomas) variant of acrolentiginous malignant melanoma. In Asia, however, the incidence is 20-30%.
Occurrence/EpidemiologyThis section has been translated automatically.
1-2% of all malignant melanomas
ManifestationThis section has been translated automatically.
Age at diagnosis 55-65 years.
LocalizationThis section has been translated automatically.
Preferably the fingernails (61%) and here especially the thumbnails are affected.
Clinical featuresThis section has been translated automatically.
The first clinical sign is the longitudinal stripe-like melanonychia (see also there for differential diagnosis), often accompanied by a periungual hyperpigmentation ( Hutchinson sign).
Progressive growth of the pigment tumor leads to a grey-black discoloration of the nail and later to a clumsy lifting and destruction of the nail plate.
In about 30% of cases amelanotic subungual melanomas develop. These are less painful, reddish tumors with a destroyed or lifted nail plate. Also missing is the otherwise obligatory longitudinal stripping of the nail plate.
Helpful for the clinical classification of a subungual melanoma is the ABC rule defined by Levit EK et al:
- A = Age, higher age, 5th-7th decade
- B = Pigmented band: band-shaped pigmentation, brown-black, >0,3cm (see fig.)
- C = Change: recent rapid change in width and/or nail plate morphology
- D = Single digit involvement: concerns only 1 nail, most often thumb, followed by big toe or index finger
- E = Extension of the pigment into the perinychium (Hutchinson sign)
- F = Family history (melanoma, dysplastic nevi syndrome)
DiagnosisThis section has been translated automatically.
Diagnostic confirmation, e.g. via histological detection of melanin in the nail plate (Fontana-Masson staining).
TherapyThis section has been translated automatically.
In case of melanocytic origin nail extraction and excision of the pigmented part in the nail bed with sufficient safety distance, if necessary amputation of the affected digitus.
LiteratureThis section has been translated automatically.
- Baccard M et al (2009) Acrolentiginous melanoma. Ann Dermatol Venereol 136:389-390
- Baumert J et al. (2009) Time trends in tumor thickness vary in subgroups: analysis of 6475 patients by age, tumor site and melanoma subtype. Melanoma Res 19:24-30
- Gutman M et al (1985) Acral (volar-subungual) melanoma. Br J Surg 72: 610-613.
- Koushk Jalali B et al (2018) Subungual melanoma. CMAJ. Aug 27;190(34):E1018. doi: 10.1503/cmaj.180513.
- Levit EK et al (2000) The ABC rule for clinical detection of subungual melanoma. J Am Acad Dermatol 42:269-274.
- Mishima Y, Nakanishi T (1985) Acral lentiginous melanoma and its precursor--heterogeneity of palmo-plantar melanomas. Pathology 17: 258-265
- Schmidt-Wendtner et al (2003) Disease progression in patients with cutaneous melanomas (tumor Thickness < 0,75 mm): clinical and epidemiological data from the tumor center Munich 1977-1998. Br J Dermatol 149: 788-793.
- Schoenewolf NL et al (2012) Sinonasal, genital and acrolentiginous melanomas show distinct characteristics of KIT expression and mutations. Eur J Cancer 48:1842-1852
- Tuominen L, Strengell L (1992) Melanoma of palms, soles, and nail-beds. Scand J Plast Reconstr Surg Hand Surg 26: 287-292.