A rare and challenging case of amelanotic subungual melanoma from Syria

Subungual melanoma accounts for 1.9% of cutaneous melanomas. Amelanotic cases, comprising 15-25%, poses a significant diagnostic challenge because it can be misdiagnosed as other traumatic, inflammatory, or neoplastic conditions. This often leads to delayed diagnosis and subsequently, a poor prognosis. We present a case of an 83-year-old woman with a bleeding, painful and progressive lesion on the nail area of her right middle finger initially misdiagnosed as paronychia at a rural clinic four months ago. An incisional biopsy confirmed the diagnosis of amelanotic subungual melanoma. Amputation of the affected finger was performed successfully. Imaging studies showed no metastatic disease. This case underscores the importance of early recognition and management of subungual melanoma, particularly in remote rural areas, to optimize patient outcomes.