Subungual Hematoma

September 14, 2005
Jonathan S. Crane, MD

,
Reynold C. Wong, MD

A 45-year-old woman who had had several melanomas removed was concerned because of hyperpigmentation beneath her toenail. Some distal onycholysis was also noted. Because of the patient's history and the fact that she could not definitely recall injuring the toe, a partial nail evulsion was performed. Fortunately, the only finding was dried blood.

A 45-year-old woman who had had several melanomas removed was concerned because of hyperpigmentation beneath her toenail. Some distal onycholysis was also noted. Because of the patient's history and the fact that she could not definitely recall injuring the toe, a partial nail evulsion was performed. Fortunately, the only finding was dried blood.

Dr Reynold C. Wong of Sacramento, Calif, notes that hyperpigmentation of the nail plate, especially with a clear history of trauma, is almost always due to a subungual hemorrhage. If, however, such history is not forthcoming, biopsy or surgical exploration is strongly recommended. Untreated subungual melanomas can have disastrous consequences.