Melanoma arising under the nail.

Subungual melanoma, a rare and easily misdiagnosed neoplasm, affected 52 patients. The lesion usually appeared as a dark spot under the nail, causing its destruction at a later stage. Diagnosis was missed by primary care physicians in 42% of the cases. Management in the hospital consisted of amputation of the involved finger or toe with or without regional node dissection. The study indicated that proper amputation should be at the tarsometatarsal or the carpometacarpal level. It also showed the node dissection should best be performed at the time of amputation, regardless of whether the nodes are clinically involved or not. Besides nodal metastasis, prognosis is adversely affected by nail destruction caused by the tumor. Subungual melanomas of the fingers have a better prognosis.