Subungual melanoma, a relatively uncommon disease, has a worse prognosis than cutaneous melanoma in other sites. Both this life-threatening disease and its treatment cause cosmetic and functional impairment to the patient. The diagnosis is often delayed and resulting an advanced disease at presentation. The important clinical manifestation, diagnosis and latest treatments for subungual melanoma are reviewed. Electronic databases of Medline, PubMed, and the Cochrane library were searched with the key word “subungual melanoma”. A clinical scoring system is proposed by the authors to stratify patients to undergo biopsy, making earlier diagnosis of this disease possible. The latest trend of treatment involves wide local excision at a more distal level of the affected digit, in contrast to radical amputation of the digit in the past. Studies have shown that this does not decrease the survival nor increase local recurrence, but reduces the functional impairment for the patient. This review aims to summarise the approach to subungual melanoma for clinicians, so that they can recognise and diagnose this disease early and generate the best functional and cosmetic outcome for the patients.
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