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July 1994

Suspicious Violaceous Subungual Nodule

Author Affiliations

National Cancer Institute, National Institutes of Health, Bethesda, Md

Arch Dermatol. 1994;130(7):918. doi:10.1001/archderm.1994.01690070113020

REPORT OF A CASE  A 65-year-old retired coal miner presented with a 3-month history of an enlarging, tender, right subungual nodule.He underwent a right nephrectomy 7 years before for a renal cell carcinoma with clear cell features and capsular invasion. During a routine screening for black lung disease 3 years later, his chest roentgenogram was abnormal.Thoracic and abdominal computed tomographic scans were obtained that revealed pleural, parenchymal, and paraver-tebral metastases. Bilateral lung metastases progressively enlarged and were resected 2 years later. Despite evidence of bronchiolar and vascular invasion, the patient refused further surgery. On referral, he entered the interleukin-2/lymphokine-activated killer cell protocol that temporarily stabilized his disease.Physical examination revealed a pale, ill-appearing man. The blood pressure was 150/80 mm Hg. A solitary 1-cm fluctuant, violaceous subungual nodule on the right thumb displaced the shortened and discolored nail plate (Figure 1 and Figure 2). Laboratory studies included liver function tests, complete blood cell count and alkaline phosphatase and calcium levels; all were within normal limits. A fine-needle aspiration (FNA) was performed and the specimen is shown in