Eight months ago, this 67-year-old man first noticed a dark lesion under his second fingernail. Since then, it has not changed. It is completely asymptomatic, but it hasn’t grown out, either, which concerns the patient and his primary care provider. The latter recommends a visit to dermatology.
The patient denies any history of trauma to either the finger or the nail and says he hasn’t had any similar problems with his other fingernails. His history does include excessive sun exposure, particularly during his young adulthood. He has had several basal cell carcinomas removed over the years, mostly from his face.
EXAMINATION
The lesion in question is 4 mm, dark brown to black, and macular. It is located under the mid portion of his right index fingernail. No abnormality of the nail plate itself is felt, and all his other fingernails appear normal.
A presumptive diagnosis of subungual hematoma is challenged by the given history of at least eight months without any change or movement to the lesion. This fact is at odds with the nature of a hematoma.
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