Is This Subungual Pigmented Streak Cause for Concern?

During a routine physical examination, a 3-mm dark brown streak is noted on the fourth toe of a 54-year-old man. The patient does not recall any trauma to the foot and was unaware of the discoloration until it was pointed out to him. There is no hyperpigmentation of adjacent skin.

What do you suspect?

(Case and photo courtesy of Caron M. Grin, MD and Marti Jill Rothe, MD.)

Answer: Subungual melanoma

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