OCAD-
I encountered these two subungual cases recently. Reminder for me to consider malignancies with subungual masses.
First case is melanoma. Something I learned was that subungual melanomas are often amelanotic (this case was indeed amelanotic on histopathology). Therefore, you may not see the classic imaging characteristics of melanin (ie T1 hyperintensity). There is also often a delay in diagnosis of subungual melanomas as it may not be considered clinically and can be confused for a bruise.
Subtle erosion distal phalanx
T1, T2FS, Post-gad
MRI demonstrates a nonspecific subungual soft tissue mass. My differential for this is broad. This was amelanotic melanoma.
Second case is squamous cell carcinoma. The below two xrays were 2 months apart. Subtle lucency in distal phalanx on initial x-ray. Pretty impressive osseous destruction 2 months later. MRI with destructive heterogeneous mass. Understandably, SCC can be confused for infection.
T1, T2FS, Post-gad
Best
Drew
