%0 Journal Article
%T Relearning the lesson ¨C amelanotic malignant melanoma: a case report
%A Ezekiel Oburu
%A Alberto Gregori
%J Journal of Medical Case Reports
%D 2008
%I BioMed Central
%R 10.1186/1752-1947-2-31
%X With malignant melanoma early diagnosis is vital. Amelanotic malignant melanoma often presents in unusual ways, often evading early diagnosis, resulting in a poorer prognosis. Differential diagnosis can include paronychia, pyogenic granuloma, glomus tumor, and subungual haematoma. Our case highlights that any persistent ulcer adjacent or below the nail not responsive to treatment should raise suspicion.A 55 year old male presented with a 10 month old painless ulcer of the left middle finger (Figure 1). Being a nail biter the initial diagnosis was paronychia having discharged pus. Nail removal was attempted and antibiotics were administered. The wound was subsequently dressed for months without improvement.Examination revealed an ulcerated swollen fingertip with partial nail loss.Lymphadenopathy was not clinically evident. Haematological parameters were normal. Radiology revealed a distal phalangeal radiolucent lesion (Figure 2). An excision biopsy diagnosed amelanotic melanoma with a Breslow level of 6 mm. The patient later developed pulmonary metastasis and died.Melanoma not only presents to dermatologists, but to other medical practitioners and early diagnosis is vital. Patients discover approximately half of melanomas, a quarter are detected by medical providers [1]. Amelanotic melanomas comprise only 2% of melanomas [2] and is most commonly subungual [3].Prognosis is dependant on the Breslows level at time of diagnosis. In amelatonic melanoma the cues leading to diagnosis are often absent, leading to reports of missed diagnoses and poorer prognoses. Evaluating this patient's presentation suggests that an earlier diagnosis was possible. Nail loss can occur in subungual melanoma and lesions affecting the nail bed associated with nail plate lifting are suspicious [4]. Lack of ulcer healing is another sign suggestive of underlying malignancy. The radiological appearance was also suggestive of malignancy. Elmets [5] reported a sixty-two year old man with a right hall
%U http://www.jmedicalcasereports.com/content/2/1/31