Introduction:

Subungual melanoma is a rare and potentially aggressive form of melanoma that occurs beneath the nail. This article provides an overview of subungual melanoma, including its characteristics, risk factors, signs and symptoms, diagnostic considerations, and treatment options.

Understanding Subungual Melanoma:

• Definition: Subungual melanoma refers to the development of melanoma in the tissues beneath the nail, often originating from the nail matrix or nail bed.
• Melanoma: Melanoma is a type of skin cancer that arises from the pigment-producing cells (melanocytes) and can occur anywhere on the body, including beneath the nails.

Risk Factors for Subungual Melanoma:

• Age and Gender: Subungual melanoma tends to occur more frequently in adults, with a higher prevalence in individuals over the age of 50. It affects both men and women, although men may have a slightly higher risk.
• Ethnicity: People with darker skin types, including individuals of African, Asian, or Hispanic descent, have a lower incidence of subungual melanoma compared to those with lighter skin.
• Family History: Having a family history of melanoma or a personal history of melanoma increases the risk of developing subungual melanoma.

Signs and Symptoms:

• Nail Pigmentation Changes: The most common early sign of subungual melanoma is a darkened band or streak of pigment beneath the nail that does not resolve over time.
• Nail Discoloration: The nail may show variations in color, such as brown, black, or bluish discoloration, which may spread or involve the surrounding tissues.
• Nail Deformation: As the tumor grows, it can cause changes in the nail shape, including thickening, ridges, or lifting of the nail from the nail bed.
• Bleeding or Ulceration: Advanced subungual melanoma may lead to bleeding, ulceration, or the formation of a nodule beneath the nail.

Diagnostic Considerations:

• Dermatological Examination: A thorough examination of the affected nail and surrounding skin is performed by a dermatologist or other healthcare professional.
• Biopsy: A biopsy involves the removal of a small sample of tissue for microscopic examination, providing a definitive diagnosis of melanoma.
• Imaging Studies: Imaging tests such as ultrasound, magnetic resonance imaging (MRI), or computed tomography (CT) scans may be recommended to assess the extent of the disease and evaluate lymph node involvement.

Treatment Options for Subungual Melanoma:

• Surgical Excision: Surgical removal of the affected nail unit and a safety margin of surrounding healthy tissue is the primary treatment for subungual melanoma.
• Sentinel Lymph Node Biopsy: In cases where the melanoma has a high risk of spreading, a sentinel lymph node biopsy may be performed to assess lymph node involvement.
• Immunotherapy or Targeted Therapy: In advanced cases or cases with metastasis, systemic therapies such as immunotherapy or targeted therapy may be considered.

Follow-Up and Prognosis:

• Regular Monitoring: Following treatment, regular follow-up visits are essential to monitor for any signs of recurrence or metastasis.
• Prognosis: The prognosis for subungual melanoma depends on various factors, including the tumor thickness, extent of spread, and lymph node involvement.

Conclusion:

Subungual melanoma is a rare but serious form of melanoma that develops beneath the nail. Early detection and prompt treatment are crucial for improving outcomes. Understanding the signs and symptoms, obtaining a proper diagnosis through biopsy, and receiving appropriate treatment tailored to the individual's condition are essential in managing subungual melanoma. Regular follow-up and monitoring play a crucial role in detecting any recurrence or metastasis.

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