Subungual Pigmentation

The patient is a 49 yo woman who noted a discolored right great toe nail for ~ a week.  After a web search she became quite agitated and presented at the office as a walk-in patient.  The area was painless and there was no history of trauma.

O/E:  The patient is an anxious-appearing Korean woman. There was a dark purple area at the proximal and lateral portion of the right great toe nail.  Dermoscopically no brown or black color could be seen.  The nail was scraped down and the base appeared reddish.

Unfortunately the second photograph is a bit blurry.

Impression:  She short history and the pigment suggest subungual hematoma.  It would be unusual for a subungual melanoma to present this rapidly.

Plan:  I will follow this.  I expect it will take many months for this to grow out.