Early diagnosed but late treated subungual melanoma.

Subungual melanoma is a relatively rare disease with a reported incidence of between 0.7% to 3.5% of all me-lanoma cases in the general population (1). Most com-mon sites of involvement are the big toe, the thumb and the index and ring fingers, respectively (2–4). Common signs include pigmentation of the nail bed, nail loss, and nail destruction, which is sometimes misdiagnosed as onychomycosis (5–7). Subungual melanoma has been associated with a poor prognosis, with a 10–30% 5-year survival, usually attributed to the delay in diagnosis (8–11). Early dermoscopic examination and biopsy of suspicious lesions, followed by amputation of the digit in those proving positive is the treatment of choice (8).CASE REPORTA 65-year-old woman presented with a longitudinal melanotic lesion of the nail bed of the left index finger for one year, associated with destruction of the overlying nail. Dermoscopic examination revealed longitudinal pigmented streaks in the entire nail plate with haphazard pigmentation distributed in a disorderly fashion on the cuticle and proximal nail fold (Hutchinson’s sign). She was diagnosed as having subungual melanoma