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An otherwise healthy 13-year-old boy was noted to have a discolouration arising from the nail bed of the left thumb. The lesion exhibited brisk linear transformation since it was initially noticed 4 months prior. There was no family history of melanoma, and he was not taking any medications. Examination confirmed a symmetrically pigmented lesion in the subungual area of the left thumb, measuring 4 mm in width (figure 1). There was extension of the black pigmentation into the proximal nail fold (Hutchinson's sign), measuring 1 mm in length. A 6 mm punch was used to excise a circular segment of the nail, followed by a 4 mm punch biopsy of the subungual area (figure 2 …