Early diagnosed but late treated subungual melanoma.

Fig. 2. Strong HMB-45 positivity of the tumour cells (×200). Sir, Subungual melanoma is a relatively rare disease with a reported incidence of between 0.7% to 3.5% of all melanoma cases in the general population (1). Most common 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).