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“Hitting the nail on the head”
  1. A Fries1,
  2. I Higginson2
  1. 1The Sickbay, 42 Commando Royal Marines, Bickleigh Barracks, Plymouth, UK
  2. 2Derriford Hospital, Plymouth, UK
  1. Correspondence to:
 Dr I Higginson
 Emergency Department, Derriford Hospital, Plymouth PL6 8DH, UK; ian.higginson{at}


Subungual malignant melanoma is a rare form of malignancy that can present at an advanced stage. We describe a case that was diagnosed after a presentation to the emergency department for a traumatic injury of the affected area.

Initial presentations of malignant disease and its complications form a relatively low proportion of the caseload of emergency doctors. In this case, a patient presented after a minor injury that had failed to recover; subsequent investigation of this injury led to the diagnosis of subungual malignant melanoma in an otherwise asymptomatic patient. This is a rare case which presented in an atypical fashion, with a confounding history of minor trauma. It is presented to highlight the differential diagnosis of destructive bone lesions.

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  • Competing interests: None declared.

  • Informed patient consent received.

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