Hutchinson’s Sign in Subungual Melanoma In Situ ( 1 фото )

A 71-year-old man presented to the dermatology clinic with a 2-year history of a gradually darkening line on his left thumbnail. He had not sought evaluation previously because he had hoped the nail changes would resolve on their own. Physical examination was notable for an 8-mm-wide brown discoloration along the ulnar aspect of the left thumbnail and an irregularly shaped, sharply demarcated patch of hyperpigmentation on the proximal nail fold (Panel A). Hyperpigmented macules were also observed on the tip of the thumb (Panel B). The darkening of the skin around the hyperpigmented fingernail was consistent with Hutchinson’s sign — a finding that arouses concern for subungual melanoma but may be seen in benign conditions. When Hutchinson’s sign is present, a biopsy of the nail matrix — not the periungual hyperpigmentation — is warranted to evaluate for melanoma. In this case, a tangential excision of the hyperpigmented area of the nail matrix revealed melanocytes with limited atypia and enlarged, polymorphic nuclei in the epidermis without invasion of the dermis. A diagnosis of subungual melanoma in situ was made. A multidisciplinary melanoma treatment committee recommended wide local excision, but the patient opted for amputation of the distal tip of the thumb. At a 6-month follow-up visit, the patient had recovered well and had no recurrence.
Marcel Pasch, M.D., Ph.D. , and Julie Tutein Nolthenius, M.D.
Published September 3, 2025
N Engl J Med 2025;393: e13
DOI: 10.1056/NEJMicm2504151
VOL. 393 NO. 9

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