Subungual Amelanotic Melanoma Masquerading as Onychomycosis

Subungual amelanotic melanoma is rare. In addition, amelanotic melanoma can mimic non-melanocytic tumors. A 67-year-old woman had a four-year history of dystrophy of the left fourth fingernail. Periodic acid-Schiff staining of the nail plate demonstrated fungal hyphae, establishing a diagnosis of tinea unguium. The nail plate subsequently detached and the underlying nail bed showed a red, friable mass that was biopsied and confirmed a diagnosis of melanoma. In conclusion, additional morphologic change of a persistent nail dystrophy—even with a biopsy-confirmed diagnosis of onychomycosis—may require consideration for repeat evaluation, including a biopsy, to exclude the possibility of a subungual malignant tumor.