Amelanotic subungual melanoma presenting as a non-healing post-operative nail bed wound - A case report

Subungual melanoma is a rare malignancy of the nail unit that is frequently associated with delayed diagnosis and poor outcomes. The amelanotic variant presents a particular diagnostic challenge due to the absence of pigmentation and its resemblance to benign or inflammatory conditions. We report the case of a 61-year-old female referred to a podiatric foot and ankle surgery unit with a persistent non-healing wound following left hallux total nail avulsion. Despite repeated courses of antibiotics and ongoing wound care, the lesion failed to resolve. Histopathological examination ultimately confirmed malignant melanoma with a Breslow thickness of at least 2.1 mm and features consistent with vertical growth phase (≥pT3b). This case highlights the importance of reconsidering the diagnosis in patients with non-healing nail bed lesions and maintaining a low threshold for biopsy where expected healing does not occur.