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This rare case report describes a 39-year-old patient with subungual amelanotic melanoma affecting the nail unit of the right thumb. The lesion enlarged over a year, was repeatedly misdiagnosed and treated without response, and later showed positive sentinel node biopsy. Diagnostic difficulty is emphasized due to absent pigmentation and mimicry of benign or malignant conditions.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/unusual-location-of-subungual-amelanotic-melanoma-in-39-year-old-patient-a-rare-case-report/341070/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/unusual-location-of-subungual-amelanotic-melanoma-in-39-year-old-patient-a-rare-case-report/341070.png","ImageObject",300,407,{"name":92,"@type":93},"Ava Thompson","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-29","2026-09-22",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",12,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"What makes amelanotic subungual melanoma difficult to diagnose?","Question",{"text":113,"@type":114},"It is rare and lacks pigmentation, so it mimics many benign and malignant neoplasms and has few clinical diagnostic features. The high growth rate can also narrow the window for early detection.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"What happened in this reported 39-year-old patient?",{"text":118,"@type":114},"The patient had a painful progressive subungual lesion of the right thumb that enlarged over a year. The lesion was repeatedly misdiagnosed and treated without response, and sentinel node biopsy was positive, prompting treatment at a specialized hospital.",{"name":120,"@type":111,"acceptedAnswer":121},"Why is early diagnosis important in subungual amelanotic melanoma?",{"text":122,"@type":114},"Late diagnosis is associated with an increased risk of metastases and poorer outcomes. Early diagnosis offers the best chance for survival and should be considered for any non-healing finger lesion.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},341070,1790527833,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":19,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":52},1649267921044,"https://us-avatar.wpscdn.com/avatar/1800007509477c92dfb?_k=1786009248482753345","’Case Report  \nUnusual location of subungual amelanotic  \nmelanoma in 39-year-old patient: a rare case report  \nSaja Ahmad Karaja, MDa,* , Mai Abdulsalam Halloum, MDa , Sanaa Yasser Mansour, MDb , Alae Aldin Almasri, MDb  \nIntroduction and importance: Melanoma represents only 1% of all skin cancers. Acral lentigious melanoma (ALM) which usually arises from feet, is the rarest main subtype of melanoma. Subungual melanoma (SUM) is a rare variant of ALM. Amelanotic melanoma (AM) is found only in 4–27 .5% of melanomas, and the mean age for patients affected by AM exceeds 50 years. Late diagnosing leads to unfavourable prognosis.  \nCase presentation: The authors present a case of subungual amelanotic melanoma that affected the nail unit of the right thumb which is a rare case, especially when the patient is only 39 years old. The lesion enlarged over a year and was misdiagnosed many times and treated with no response. Sentinel node biopsy was positive and the patient was moved to a specialized hospital for treatment.  \nClinical discussion: Diagnosing subungual amelanotic melanoma is challenging, not only because it isthe rarest, but also it mimics many benign and malignant neoplasms due to the lack of pigmentation, in addition to the absence of clinical diagnostic features. AM exhibits a high growth rate helping in limiting the window for early detection.  \nConclusions: Lately diagnosed subungual amelanotic melanoma usually associates with an increased risk of metastases, So it should be considered as a cause of any non-healing lesion. Early diagnosing gives patients the best chance for survival. Keywords: amelanotic, case report, finger, melanoma, nail, subungual  \nIntroduction  \nSkin cancer is typically classified into non-melanoma skin cancer (NMSC) which is more common, and malignant melanoma (MM)[1] . NMSC includes basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) as main types[2] . Melanoma was first documented in the fifth century by Hippocrates[3] . Melanoma represents only 1% of all skin cancers, causing over 80% of their deaths[4] . Acral lentiginous melanoma (ALM) which originates on the palms and soles[5], is the rarest subtype of melanoma cases, accounting only 4–10% of all of them[6] . ALM lesions are often misdiagnosed as fungal infections, warts, or diabetic foot ulcers so it is usually lately diagnosed[5] . Subungual melanoma (SUM) is typically a variant of ALM[7] . It is thought that ALM is not associated with sun exposure as other melanomas and it is more common to originate from the feet than the hands[8] . Late and invasive SUM cases usually impose aggressive treatment,  \naFaculty of Medicine, Hama University and bMinistry of Health, Hama, Syria Sponsorships or competing interests that maybe relevant to content are disclosed atthe end of this article  \n*Corresponding author. Address: Hama City, Hama, Syria. Tel.: + 963 996 979 935. [E-mail: sajaahmadkaraja935@gmail.com](E-mail: sajaahmadkaraja935@gmail.com) (S.A. Karaja).  \nCopyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.  \nAnnals of Medicine & Surgery (2024) 86:2314–2317  \nReceived 4 January 2024; Accepted 13 February 2024  \nPublished online 28 February 2024  \n[http://dx.doi.org/10.1097/MS9.0000000000001860](http://dx.doi.org/10.1097/MS9.0000000000001860)  \nHIGHLIGHTS  \n• Subungual and amelanotic melanoma cases are extremely uncommon subtypes of melanoma, which is the rarest and most lethal main type of skin cancer.  \n• Subungual melanoma is frequently found on feet more than the hand nails.  \n• Amelanotic melanoma’s lack pigmentation resembles numerous diseases, making it challenging to make an accurat","cbCaitbOGUfX5Kyi","https://ap.wps.com/l/cbCaitbOGUfX5Kyi","pdf",504606,"English","# Introduction\n## Case presentation\n## Clinical discussion\n## Conclusions\n# Case presentation\n## Patient history and examination\n## Diagnostic workup and management","[{\"question\":\"What makes amelanotic subungual melanoma difficult to diagnose?\",\"answer\":\"It is rare and lacks pigmentation, so it mimics many benign and malignant neoplasms and has few clinical diagnostic features. The high growth rate can also narrow the window for early detection.\"},{\"question\":\"What happened in this reported 39-year-old patient?\",\"answer\":\"The patient had a painful progressive subungual lesion of the right thumb that enlarged over a year. The lesion was repeatedly misdiagnosed and treated without response, and sentinel node biopsy was positive, prompting treatment at a specialized hospital.\"},{\"question\":\"Why is early diagnosis important in subungual amelanotic melanoma?\",\"answer\":\"Late diagnosis is associated with an increased risk of metastases and poorer outcomes. Early diagnosis offers the best chance for survival and should be considered for any non-healing finger lesion.\"}]","Unusual location of subungual amelanotic melanoma in 39-year-old patient - a rare case report | PDF",1790040147]