Ungual Melanoma Disguised by Onychomycosis
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Ungual melanoma is known to be frequently misdiagnosed, and the primary misdiagnosis of ungual melanoma includes onychomycosis. We report a very rare case of onychomycosis concealing ungual melanoma in situ. A 52- year-old male patient presented with a yellow to brown thickened left great toenail that had existed for 10 years. In the front view, Hutchinson's sign which refers periungual extension of brown-black pigmentation from melanonychia was also observed on his hyponychium. First, fungal infection of his toenail was confirmed with positive KOH result. Next, a nail biopsy after nail avulsion was done to assess Breslow depth and to determine surgical margin. And ungual melanoma was diagnosed with immunohistochemical stains. Non-amputative wide local excision with 5 mm surgical margin followed by skin grafting was done Unfortunately in three years ungual melanoma in situ has recurred 2 times and then progressed to invasive malignant melanoma, so he was referred to the Department of plastic surgery for further invasive surgical treatment and regularly monitored to check the recurrence. According to a prior retrospective study, 52% of ungual melanomas were clinically misdiagnosed. Thus, proper diagnosis of ungual melanoma is very important for the patients' better prognosis. It would be important for physicians to examine the nail plate as well as the underneath structures for patients with nail disease including onychomycosis.
Abstract
Ungual melanoma is known to be frequently misdiagnosed, and the primary misdiagnosis of ungual melanoma includes onychomycosis. We report a very rare case of onychomycosis concealing ungual melanoma in situ. A 52- year-old male patient presented with a yellow to brown thickened left great toenail that had existed for 10 years. In the front view, Hutchinson's sign which refers periungual extension of brown-black pigmentation from melanonychia was also observed on his hyponychium. First, fungal infection of his toenail was confirmed with positive KOH result. Next, a nail biopsy after nail avulsion was done to assess Breslow depth and to determine surgical margin. And ungual melanoma was diagnosed with immunohistochemical stains. Non-amputative wide local excision with 5 mm surgical margin followed by skin grafting was done Unfortunately in three years ungual melanoma in situ has recurred 2 times and then progressed to invasive malignant melanoma, so he was referred to the Department of plastic surgery for further invasive surgical treatment and regularly monitored to check the recurrence. According to a prior retrospective study, 52% of ungual melanomas were clinically misdiagnosed. Thus, proper diagnosis of ungual melanoma is very important for the patients' better prognosis. It would be important for physicians to examine the nail plate as well as the underneath structures for patients with nail disease including onychomycosis.
참고문헌 (12)
- Thomas J, "Toenail onychomycosis : an important global disease burden", J Clin Pharm Ther, 35, pp.497~519 (2010)
- Tan KB, "Subungual melanoma: a study of 124 cases highlighting features of early lesions, potential pitfalls in diagnosis, and guidelines for histologic reporting", Am J Surg Pathol, 31, pp.1902~1912 (2007)
- 오창모, "Nationwide Trends in the Incidence of Melanoma and Non-melanoma Skin Cancers from 1999 to 2014 in South Korea", Cancer Research and Treatment, 50(3), pp.729~737 (2018), 대한암학회
- Levit EK, "The ABC rule for clinical detection of subungual melanoma", J Am Acad Dermatol, 42, pp.269~274 (2000)
- Soon SL, "Acral lentiginous melanoma mimicking benign disease : The Emory experience", J Am Acad Dermatol, 48, pp.183~188 (2003)
- Patterson RH, "Subungual malignant melanoma : a clinical-pathologic study", Cancer, 46, pp.2074~2087 (1980)
- Patel GA, "Subungual melanoma : a deceptive disorder", Acta Dermatovenerol Croat, 16, pp.236~242 (2008)
- Metzger S, "Extent and consequences of physician delay in the diagnosis of acral melanoma", Melanoma Res, 8, pp.181~186 (1998)
- Finch J, "Fungal melanonychia", J Am Acad Dermatol, 66, pp.830~841 (2012)
- Braun RP, "Diagnosis and management of nail pigmentations", J Am Acad Dermatol, 56, pp.835~847 (2007)
- Baran R, "Hutchinson's sign : A reappraisal", J Am Acad Dermatol, 34, pp.87~90 (1996)
- 김학준, "Clinical and Dermoscopic Features of Fungal Melanonychia: Differentiating from Subungual Melanoma", Annals of Dermatology, 32(6), pp.460~465 (2020), 대한피부과학회[DOI]