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Table 4 Causes of melanonychia compared with those of subungual bleeding

From: Clinical guidelines for the recognition of melanoma of the foot and nail unit

Melanonychia Subungual bleeding
Benign racial melanonychia Direct trauma
Laugier Hunziker Indirect microtrauma-end on repetitive trauma
Inflammation Haemorrhagic tendency lowering threshold for effects of trauma. eg
   • Lichen planus    • warfarin
   • Chronic paronychia    • leukaemic
   • Trauma/friction    • thrombocytopaenia
   • radiation  
Medication e.g. Subungual tumour
   • Minocycline    • squamous cell carcinoma
   • Chemotherapy    • wart
   • HIV disease or medication    • exostosis
     • melanoma
     • pyogenic granuloma
Addison's disease  
Peutz Jeghers  
Subungual naevus  
Benign melanocyte activation  
Melanoma  
Bowen's disease (in situ squamous cell carcinoma)  
Onychomycosis