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Acquired peri-ungual pigmentation
    Differential Diagnosis[Top] [Nav]
subungual malignant melanoma
    Discussion -- not available online[Top] [Nav]
    Erratum in printed version[Top] [Nav]
       *City of publication should be Philadelphia, not Philadlephia, in last footnote.
    Update Comments[Top] [Nav]
  • Thanks to Dr. Henry Schneiderman of the University of Connecticut for this reference. [101]
  • Shows a subungual melanoma lacking the Hutchinson sign. [102]
  • When the Hutchinson sign is absent, it can be difficult to correctly diagnose a pigmented streak in the nail. According to Dr. Constance Nagi of the University of California, San Diego, the following clues raise the chances that a pigmented longitudinal streak in a nail may be subungual melanoma:
    • The discoloration developes in and is limited to a single digit.
    • The lesion appears to have developed abruptly in a previously normal nail.
    • An area of nail pigmentation suddenly become darker or wider.
    • Pigmentation develops in a patient with a history of digital trauma.
    • The involved digit is the thumb, index finger, or great toe.
    • The lesion has a streak with blurred lateral borders.
    • The patient is dark skinned.
    • The patient has a history of melanoma or has risk factors for melanoma.
    [103]
  • Beware -- that subungual hematoma could predispose your patient to bacterial endocarditis, as reported in 3 cases here. [104]
    Footnotes in Print Edition[Top] [Nav]
    (1) Melanosis often not black: melanotic whitlow.
  Hutchinson J.   Br Med J. 1886;I:491.
    (2) Malignant melanoma: a review.
  Kopf AW, Bart RS, et al.   J Dermatol Surg Oncol 1977 Jan-Feb;3(1):41-125.  Pubmed  Similars
    (3) Subungual melanoma.
  Pack GT, Oropeza R.   Surg Gynecol Obstet 1967 Mar;124(3):571-82.  Pubmed  Similars
    (-) The Hand as a Mirror of Systemic Disease.
  Berry TJ. Philadelphia: FA Davis, 1963: 10.
    New References[Top] [Nav]
    101.Periungual hyperpigmentation mimicking Hutchinson's sign associated with minocycline administration.
  Mooney E, Bennett RG.   J Dermatol Surg Oncol 1988 Sep;14(9):1011-3.  Pubmed+Abstract  Similars
    102.Images in clinical medicine. Malignant melanoma.
  Zimmerman GC, Grabski WJ.   N Engl J Med 1994 Jul 21;331(3):168.  Pubmed  Similars
    103.Hutchinson's sign means subungual melanoma.
  Childs ND.   Internal Medicine News. 15 March 1998:38-39.
    104.Bacterial endocarditis following nail trauma [letter].
  Aderka D.   Arch Intern Med 1988 Mar;148(3):752, 754.  Pubmed  Similars
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    ©1986-2000 John Sotos, MD. All rights reserved.  Last updated 16:33 PDT on July 4, 2000.[Top]

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