A subungual hematoma is a benign collection of blood under the nail. Some patients confuse it with melanoma.
A red, blue or purple lesion occurring after trauma is characteristic. The concern for melanoma is sometimes raised. Subungual melanoma originates in the proximal nail fold/matrix and extends linearly outward. The subungual hematoma rarely takes on this morphology. Sometimes a Greek foot (second toe is longer than the great toe) can cause the second toe to overlap the great toe, causing lateral discoloration of the great toe.
Dermoscopy may be helpful, showing red dots and spots. Of note, subungual hemorrhages due to chemotherapy with taxanes develop in up to 80% of patients, leading to infections in 33% and affecting daily activities in 25% of patients [JAAD 2011; 65, Issue 3, Pages 624–635].
No treatment is needed. If large and painful, a small hole may be made in the nail plate to allow for drainage.
Not much of a "hematoma" here. More like subungual purpura.
Subungual hematoma drained.
Biopsy-proven subungual blood.
This is a melanoma in situ--not a subungual hematoma. Note the linear extension from the proximal nail fold.
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