Subungual melanomas represent approximately 20% in dark-skinned and oriental populations compared to about 2% of cutaneous melanomas in white populations. UV exposure seems to be an important risk factor for cutaneous melanoma. However, UV radiation is unlikely to penetrate the nail plate. Another pathogenetic factor of subungual melanoma will be discussed. 406 subungual melanomas of the hands (n = 240) and feet (n = 166) of 74 patients from the melanoma registry of the Department of Dermatology, University of Tübingen, and of 332 patients from the literature were evaluated. The hypothesis of a uniform distribution of the occurrence of subungual melanoma on the fingers and toes had to be rejected (p < 0.001 using the χ2;4,0.95 test).There was a considerable predominance of subungual melanoma localized on the thumb (58% of all fingers) and the hallux (86% of all toes). Many patients report direct trauma related to the onset of subungual melanoma. This might be explained by coincidence, increased attention to a dark area under the nail, traumatic bleeding of a subclinical subungual melanoma or mutation of melanocytes during trauma-induced proliferation. Squamous cell carcinoma is known to occur in sites of chronic trauma. Trauma could be an etiologic factor in subungual melanoma as well.

1.
Blessing K, Kernohan NM, Park KG: Subungual malignant melanoma: Clinicopathological features of 100 cases. Histopathology 1991;19:425–429.
2.
Pack GT, Oropeza R: Subungual melanoma. Surg Gynecol Obstet 1967;124:571–582.
3.
Takematsu H, Obata M, Tomita Y, Kato T, Takahashi M, Abe R: Subungual melanoma: A clinicopathologic study of 16 Japanese cases. Cancer 1985;55:2725–2731.
4.
Garbe C: Risk factors for the development of malignant melanoma and identification of risk groups in German-speaking regions. Hautarzt 1995;46:309–314.
5.
Bruls WA, Slaper H, van der Leun JC, Berrens L: Transmission of human epidermis and stratum corneum as a function of thickness in the ultraviolet and visible wavelengths. Photochem Photobiol 1984;40:485–494.
6.
Kato T, Suetake T, Sugiyama Y, Tabata N, Tagami H: Epidemiology and prognosis of subungual melanoma in 34 Japanese patients. Br J Dermatol 1996;134:383–387.
7.
Finley RK, Driscoll DL, Blumenson LE, Karakousis CP: Subungual melanoma: An eighteen-year review. Surgery 1994;116:96–100.
8.
Patterson RH, Helwig EB: Subungual malignant melanoma: A clinical-pathologic study. Cancer 1980;46:2074–2087.
9.
O’Toole EA, Stephens R, Young MM, Tanner A, Barnes L: Subungual melanoma: A relation to direct injury? J Am Acad Dermatol 1995;33:525–528.
10.
Paul E, Kleiner H, Bodeker RH: Epidemiologie und Prognose subungualer Melanome. Hautarzt 1992;43:286–290.
11.
Quinn MJ, Thompson JE, Crotty K, McCarthy WH, Coates AS: Subungual melanoma of the hand. J Hand Surg Am 1996;21:506–511.
12.
Hudson DA, Krige JE, Strover RM, King HS: Subungual melanoma of the hand. J Hand Surg Br 1990;15:288–290.
13.
Daly JM, Berlin R, Urmacher C: Subungual melanoma: A 25-year review of cases. J Surg Oncol 1987;35:107–112.
14.
Rigby HS, Briggs JC: Subungual melanoma: A clinico-pathological study of 24 cases. Br J Plast Surg 1992;45:275–278.
15.
Roberts AHN: Subungual melanoma following a single injury. J Hand Surg 1984;9:328–330.
16.
Shukla VK, Hughes LE: Differential diagnosis of subungual melanoma from a surgical point of view. Br J Surg 1989;76:1156–1160.
17.
Metzger S, Ellwanger U, Stroebel W, Schiebel U, Rassner G, Fierlbeck G: Extent and consequences of physician delay in the diagnosis of acral melanoma. Melanoma Res 1998;8:181–186.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.