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Subungual pigmentation can have benign and malignant etiologies. A common and important differential diagnosis is between subungual hematoma and subungual acrolentiginous melanoma. We have introduced Dr. Eckert Haneke's technique and our Hydrogen Peroxide modification for distinguishing these entities clinically. Dr. Haneke's technique uses the hemocult reaction to detect hematoma from the specimen, while our modification uses Hydrogen Peroxide to clear the hematoma and make the decision clinically. Both are minimally invasive techniques which can be performed without pain. Often these procedures spare the patient an unnecessary tissue biopsy with its morbidity and discomfort. Importantly, they reassure the patient that he or she has a benign disorder.
Subungual pigmentation can have benign and malignant etiologies. A common and important differential diagnosis is between subungual hematoma and subungual melanoma . The distinction can be difficult even with a dermoscope. A number of years ago, Dr. Eckart Haneke pioneered a procedure to differentiate these entities clinically. We would like to describe the Haneke procedure [2–4] and a recent modification we developed.
A patient presents with a two-month history of a brownish pigmentation of the great toe nail (Figure 1). While some recommend biopsy of the nail bed to determine if this is neoplastic or traumatic, a simpler technique exists.
Both the Haneke technique and the Hydrogen Peroxide modification can be used to effectively differentiate an old subungual hematoma from a subungual melanoma. These minimally invasive techniques are inexpensive, do not require special training, and can be performed without specialized equipment in almost any clinical setting. Often they will spare the patient an unnecessary nail bed biopsy with its morbidity and discomfort. Importantly, if positive for blood, they reassure the patient that he or she has a benign disorder.
The authors would like to thank Dr. Eckert Haneke for his valuable advice, encouragement, and assistance in preparing this manuscript.