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


  • Uwe Wollina Biological Department of Dermatology and Allergology, Municipal Hospital Dresden, Academic Teaching Hospital of the Technical University of Dresden, Friedrichstrasse 41, 01067 Dresden
  • Georgi Tchernev Department of Dermatology, Venereology and Dermatologic Surgery, Medical Institute of Ministry of Interior, and Onkoderma Policlinic for Dermatology and Dermatologic Surgery, Sofia



Nail apparatus, subungual pigmentation, cancer, melanoma, hematom


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.


Download data is not yet available.


Metrics Loading ...

Plum Analytics Artifact Widget Block


Wollina U, Nenoff P, Haroske G, Haenssle HA. The diagnosis and treatment of nail disorders. Dtsch Arztebl Int. 2016;113:509-518. PMid:27545710

Cohen PR. Metastatic tumors to the nail unit: subungual metastases. Dermatol Surg. 2001;27:280-293.

Tronnier M, Semkova K, Wollina U, Tchernev G. Malignant melanoma: epidemiologic aspects, diagnostic and therapeutic approach. Wien Med Wochenschr. 2013;163:354-358. PMid:23715934

Kim SY, Yun SJ. Cutaneous melanoma in Asians. Chonnam Med J. 2016;52:185-193. PMid:27689028 PMCid:PMC5040767

Baran R, Kechijian P. Hutchinson's sign: a reappraisal. J Am Acad Dermatol. 1996;34:87-90.

Tchernev G, Chokoeva AA, Wollina U, Lotti T. Persistent subungual and periungual hematoma versus melanoma: to cut it or to leave it? Dermatol Ther. 2016;29:150-151. PMid:26333508

Mun JH, Kim GW, Jwa SW, Song M, Kim HS, Ko HC, Kim BS, Kim MB. Dermoscopy of subungual haemorrhage: its usefulness in differential diagnosis from nail-unit melanoma. Br J Dermatol. 2013;168:1224-1229. PMid:23302009

Deinlein T, Hofmann-Wellenhof R, Zalaudek I. Acral melanoma mimicking subungual hematoma. J Am Acad Dermatol. 2016;75:e181-e183. PMid:27745646

Chaniotakis I, Bonitsis N, Stergiopoulou C, Kiorpelidou D, Bassukas ID. Dizygotic twins with congenital malalignment of the great toenails: reappraisal of the pathogenesis. J Am Acad Dermatol. 2007;57:711-715. PMid:17692994

Kaatz M, Wenzel H-C, Trebing D, Barta U, Wollina U. Yellow-Nail-Syndrom. Med Welt. 1997;48:501-503.

Mishra AK, George AA, George L. Yellow nail syndrome in rheumatoid arthritis: an aetiology beyond thiol drugs. Oxf Med Case Reports. 2016;2016:37-40. PMid:26989491 PMCid:PMC4794558

Decker A, Scher RK, Avarbock A. Acquired congenital malalignment of the great toenails. Skin Appendage Disord. 2016;1:147–149. PMid:27171597 PMCid:PMC4857820

Wollina U, Wollina K. Growth malalignment of the great toenails - A cause of chronic relapsing paronychia in infants. Z Hautkrankh. 1995;70:35-37.

Braswell MA, Daniel CR 3rd, Brodell RT. Beau lines, onychomadesis, and retronychia: A unifying hypothesis. J Am Acad Dermatol. 2015;73:849-855. PMid:26475537



How to Cite

Wollina U, Tchernev G. Subungual Nail Pigmentation and Malalignment of the Great Toe Nail in a Cancer Patient - A Diagnostic Challenge. Open Access Maced J Med Sci [Internet]. 2017 Jul. 20 [cited 2023 Jan. 26];5(4):467-9. Available from:

Most read articles by the same author(s)

1 2 3 4 5 6 7 8 9 10 > >>