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Centre for Hand and Upper Limb Surgery, Wrightington Hospital, Wigan, Lancs, UK.
Between six and eight per cent of cases of malignant melanoma lack pigmentation on macroscopic examination, making accurate early diagnosis difficult. Delays in diagnosis and misdiagnosis are common in cases of subungual melanoma. We report a patient with an amelanotic subungual malignant melanoma who presented with a lesion that closely resembled a pyogenic granuloma. Since amelanotic melanoma usually presents as a vascular or ulcerating nodule, it should be considered in the differential diagnosis of a wide range of superficial lesions that occur in the hand.
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