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Background: The traditional treatment of choice for subungual melanoma has been that of amputation. However, more recently a conservative approach with wide resection especially for paediatric subungual melanoma in-situ has been adopted. Case report: This is a case of a paediatric left little finger subungual melanoma in-situ. The child underwent wide resection and reconstruction with a full-thickness skin graft. 3 years post operation, the child has no clinical recurrence and has good cosmesis and function. We discuss the controversies and rationale for our treatment. Conclusion: We recommend considering wide resection and reconstruction with full-thickness skin graft as a viable treatment for pediatric subungual melanoma in-situ.