Indian Journal of Dermatology
  Publication of IADVL, WB
  Official organ of AADV
Indexed with Science Citation Index (E) , Web of Science and PubMed
 
Users online: 1804  
Home About  Editorial Board  Current Issue Archives Online Early Coming Soon Guidelines Subscriptions  e-Alerts    Login  
    Small font sizeDefault font sizeIncrease font size Print this page Email this page


 
Table of Contents 
CORRESPONDENCE
Year : 2021  |  Volume : 66  |  Issue : 2  |  Page : 216-218
Subungual angiokeratoma simulating a malignant melanoma: A case report and mini review


1 Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
2 Department of Dermatology, Xiangya Hospitaly; Hunan Engineering Research Center of Skin Health and Disease; Hunan Key Laboratory of Skin Cancer and Psoriasis, Central South University, Changsha, China

Date of Web Publication16-Apr-2021

Correspondence Address:
Juan Su
Department of Dermatology, Xiangya Hospitaly; Hunan Engineering Research Center of Skin Health and Disease; Hunan Key Laboratory of Skin Cancer and Psoriasis, Central South University, Changsha
China
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijd.IJD_141_20

Rights and Permissions



How to cite this article:
Yang X, Zhao S, Tang Y, Su J. Subungual angiokeratoma simulating a malignant melanoma: A case report and mini review. Indian J Dermatol 2021;66:216-8

How to cite this URL:
Yang X, Zhao S, Tang Y, Su J. Subungual angiokeratoma simulating a malignant melanoma: A case report and mini review. Indian J Dermatol [serial online] 2021 [cited 2021 Oct 21];66:216-8. Available from: https://www.e-ijd.org/text.asp?2021/66/2/216/313745




Sir,

Angiokeratomas are a group of benign vascular lesions characterized by reactive hyperkeratosis and dilated vessels in the papillary dermis. Five variants are currently recognized: Solitary/multiple angiokeratomas, angiokeratomas of the scrotum and vulva, angiokeratoma of Mibelli, angiokeratoma corporis diffusum, and angiokeratoma circumscriptum. Solitary angiokeratomas may arise on any site of the body, especially the lower extremities. However, its occurrence in the nail is an exceptional case, with only 3 cases described in the literature so far[1],[2],[3] [Table 1]. Herein, we report a case of subungual angiokeratoma of the right fourth fingernail that clinically mimicked malignant melanoma (MM) of the nail bed, which is the first case reported in China.
Table 1: Clinical characteristics of reported subungual angiokeratomas

Click here to view


A 71-year-old female was admitted to our department due to black spots under the fourth fingernail of her right hand that had existed for more than one year. The patient had accidentally found a longitudinal black line approximately 1 mm wide under the fourth fingernail of her right hand with no apparent cause. The black line had grown rapidly in width to cover almost the entire finger in the past six months without any discomfort. Physical examination revealed 0.8 cm*1.2 cm black spots under the fourth fingernail of the right hand [Figure 1]. The dark purplish red lesion could be seen at the edge, with a surrounding light yellow halo. Hutchinson's sign was negative. The patient was considered to have MM instead of vascular disease as the first clinical diagnosis. Skin biopsy, rather than dermoscopy, was performed. Interestingly, the pathological results showed the typical manifestations of subungual angiokeratoma [Figure 2]. The subsequent treatment involved complete excision of the lesion with an incision margin enlargement of 5 mm and skin grafting. The patient is still in follow-up with satisfactory efficacy [Figure 3].
Figure 1: Clinical Manifestations: Black spots approximately 0.8 cm*1.2 cm under the fourth fingernail of the right hand

Click here to view
Figure 2: Histopathology: Above the massive dilated and congested capillaries, hyperkeratosis and acanthosis can be seen (H and E, 20×)

Click here to view
Figure 3: Postoperative healing was good

Click here to view


In our case, the lesion started as a longitudinal black line under the nail. Subungual pigmentation has extremely broad differential diagnoses, including subungual hemorrhage, melanocytic lesions, nail apparatus tumor, fungal infection, drugs, radiation, trauma, and inflammatory disorders.[4] The most concerning cause is a potentially life-threatening subungual melanoma. In our case, the subungual pigmentation had existed for a long time and developed rapidly recently. Therefore, the patient was highly suspected of having MM. For lesions caused by subungual pigmentation, we can always perform noninvasive dermoscopy to distinguish benign lesions from malignant lesions. However, considering that dermoscopy relies on the experience and skill of the operator, histopathological examination is still an indispensable gold standard for suspicious lesions.[5]

Interestingly, subungual pigmentation might have a predilection for occurring on the fourth nail. This phenomenon still needs to be confirmed by additional reports since only 4 cases have been recorded so far. It is therefore difficult to exclude a coincidence.

In conclusion, although rare, subungual angiokeratoma still needs to be considered when patients with subungual pigmentation are seen. To differentiate it from MM, dermoscopy, and biopsy are necessary. In particular, all color changes in the nail should be examined under dermoscopy to obtain an accurate and quick diagnosis.

Declaration of patient consent

The authors certify that they have obtained patient consent form. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understand that her name and initial will not be published and due efforts will be made to conceal their identity.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Hasegawa M, Tamura A. Subungual angiokeratoma presenting as a longitudinal pigmented band in the nail. Acta Derm Venereol 2015;95:1001-2.  Back to cited text no. 1
    
2.
Sohn KM, Woo YJ, Kim JE, Kang H. A subungual angiokeratoma with characteristic clinical and dermoscopic features. Indian J Dermatol Venereol Leprol 2018;84:230-1.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Cunha N, André J, Sass U, Richert B. Subungual solitary angiokeratoma simulating a squamous cell carcinoma. Skin Appendage Disord 2018;4:152-5.  Back to cited text no. 3
    
4.
Braun RP, Baran R, Le Gal FA, Dalle S, Ronger S, Pandolfi R, et al. Diagnosis and management of nail pigmentations. J Am Acad Dermatol 2007;56:835-47.  Back to cited text no. 4
    
5.
Rtshiladze MA, Stretch JR, Stewart DA, Saw RP. Pigmented lesions of the nail bed-clinical assessment and biopsy. Aust Fam Physician 2016;45:810-3.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1]



 

Top
Print this article  Email this article
 
 
  Search
 
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Article in PDF (1,706 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  


    References
    Article Figures
    Article Tables

 Article Access Statistics
    Viewed498    
    Printed8    
    Emailed0    
    PDF Downloaded19    
    Comments [Add]    

Recommend this journal