are your nails hiding melanoma?
subungual melanoma is a form of skin cancer that develops below the surface of nails, often appearing as a black or brown streak in the nail bed.
3 minute read
pigmentation changes on a nail can also be signs of a fungal infection. getty
subungual melanoma is a form of skin cancer that develops below the surface of nails, often appearing as a black or brown streak in the nail bed. the majority of subungual melanomas occur in the thumbnail or big toenail but they can affect any nail. unlike other melanomas that are caused by the sun, it is believed that most cases of this disease are the result of trauma to the nail.
subungual melanoma occurs most commonly in middle-aged and older adults with darker skin, according to the canadian dermatology association. the condition, which is often mistaken for a bruise from a stubbed toe, is relatively common compared to other skin cancers and can become a serious concern if it spreads to other parts of the body, such as the lymph nodes or organs.
patients with a subungual melanoma generally have a poorer prognosis than those with other forms of melanoma because of delays in diagnosis and treatment. these delays have resulted in a five-year survival rate that fluctuates greatly (between 16 and 87 per cent) depending on how far the cancer has spread.
if you notice signs of a subungual melanoma below the surface of a nail, you should see a dermatologist as soon as possible.
symptoms of subungual melanoma
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because subungual melanomas form in the nail matrix (the area where nails begin to grow), they differ in appearance from the irregular-shaped moles caused by other melanomas. diagnosis can be difficult, according to healthline, because not all cases of the disease result in pigmentation changes to the nail and, when they do, these changes can be mistaken for other things. diagnosis is aided by the fact that subungual melanomas usually affect only one nail at a time. symptoms, when they appear, can include:
- a brown or black streak that may increase in size
- a bruise that refuses to heal or grow out with the nail
- separation between the nail and the nail bed
- brittleness or cracking in the nail
- bleeding in the area
- darkening skin near the nail or a deformed or damaged nail (advanced stage)
how is subungual melanoma diagnosed?
a doctor will generally need to take a biopsy of a subungual melanoma in order to make a diagnosis. this usually involves numbing the area with a local anesthetic before performing a punch biopsy, a procedure in which a tubelike instrument with a sharp end is used to obtain a small sample from the area of concern. the sample is sent to a lab that can reveal if doctors are dealing with subungual melanoma or another condition, such as a fungal infection.
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treating subungual melanoma
in order to prevent the disease from spreading to other parts of the body, surgery is required to remove the subungual melanoma and the affected nail. occasionally, a small part of a finger or toe may also need to be removed but doctors avoid this as much as possible. a sentinel node biopsy may be required to ensure the cancer has not spread to the lymph nodes.
can subungual melanoma be prevented?
subungual melanomas are difficult to avoid because, unlike other skin melanomas, they are not the result of exposure to the sun. there is some benefit in taking good care of your feet and hands, however, by wearing protective equipment when engaging in sports or other activities that may cause damage to the nails. it is also important to inspect your hands and feet from time to time to ensure there are no unusual changes in the area.
how common is subungual melanoma?
research has shown that subungual melanoma accounts for just one to three per cent of all melanomas, with a median patient age of 59. the disease appears more commonly under fingernails than toenails, with the thumb and big toe most frequently affected. a subungual melanoma can occur any time after puberty and preceding trauma has been identified as a trigger for the condition.
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where to find resources for subungual melanoma
for more information about melanomas, subungual or otherwise, check out the canadian dermatology association, the melanoma network of canada, or the calgary skin cancer centre.
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