Subungual Nail Pigmentation and Malalignment of the Great Toe Nail in a Cancer Patient - A Diagnostic Challenge

Subungual pigmentation may have a variety of underlying pathologies, but clinicians should consider malignancies such as subungual melanoma or metastasis, even if they are not common. A delayed diagnosis can dramatically worsen the prognosis. Therefore, histologic examination is highly recommended. We present a 75-year-old female cancer patient presenting with subungual blackish pigmentation of the great toe nail for several years suspicious of a subungual melanoma even by dermoscopy. Nail avulsion and histological investigations excluded melanoma. The final diagnosis was subungual hematoma with growth malalignment of the great toe nail.