Indian Journal of Dermatology
CORRESPONDENCE
Year
: 2021  |  Volume : 66  |  Issue : 2  |  Page : 216--218

Subungual angiokeratoma simulating a malignant melanoma: A case report and mini review


Xizhao Yang1, Shuang Zhao2, Yan Tang2, Juan Su2,  
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

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




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;66:216-218


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 Dec 7 ];66:216-218
Available from: https://www.e-ijd.org/text.asp?2021/66/2/216/313745


Full Text



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}

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}{Figure 2}{Figure 3}

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

1Hasegawa M, Tamura A. Subungual angiokeratoma presenting as a longitudinal pigmented band in the nail. Acta Derm Venereol 2015;95:1001-2.
2Sohn 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.
3Cunha N, André J, Sass U, Richert B. Subungual solitary angiokeratoma simulating a squamous cell carcinoma. Skin Appendage Disord 2018;4:152-5.
4Braun 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.
5Rtshiladze MA, Stretch JR, Stewart DA, Saw RP. Pigmented lesions of the nail bed-clinical assessment and biopsy. Aust Fam Physician 2016;45:810-3.