Subungual melanoma is rare, and accounts for only 2 to 3% of all melanoma in light-skinned individuals. However, it represents a significantly higher percentage of melanomas in dark-skinned and Asian people. The fingers are affected more often than the toes. Most tumors occur on the thumb or big toe. The tumor may present as nail plate loss, a non-healing ulcer, a tumor nodule or subungual pigmentation which often extends into the nail folds. The incidence of amelanotic mela­noma in all melanomas is low, although the sub­ungual region seems to be an area of predilection for amelanotic melanoma in 15 to 25% of cases. The lack of pigmentation causes the clinical appear­ance to be nonspecific for melanoma. The dif­ferential diagnosis should include a variety of benign and malignant conditions such as subungual hema- toma, paronychia, pyogenic granuloma, subungual nevus, subungual fibroma, subungual verruca, kera- toacanthoma, Bowen’s disease, subungual squamous cell carcinoma, etc. We considered amelanotic melanoma clinically in our case but also included Bowen’s disease, lichen planus, sarcoidosis.

Subungual melanoma is generally associated with poor prognosis, as the majority are deep when diag­nosed and early metastases are common. Overall 5-year survival rates range from 20% to 50%. Therefore, early diagnosis is important and sub- ungual melanoma should be considered for all slow- growing and non-healing subungual and periungual lesions, whether it is pigmented or not. kamagra soft tablets