Isla Bennett
Subungual melanoma, or skin cancer under the nail, is a rare but serious condition that can be difficult to detect. It is unrelated to sun exposure, unlike other types of melanoma, and arises from structures within the nail apparatus. Subungual melanoma usually presents as a narrow brown or black pigmented band on the nail plate, which may grow over time and lead to nail dystrophy. The early signs are often unnoticeable, but the key indication of subungual melanoma is Hutchinson's sign, where nail pigmentation extends onto the surrounding skin. While subungual melanoma can be treated surgically, early detection is critical as it can spread to other parts of the body and become lethal.
| Characteristics | Values |
|---|---|
| Type of Cancer | Subungual melanoma (skin cancer under the nail) |
| Affected Area | Nail matrix (part of the nail bed that protects the underlying skin) |
| Appearance | Dark brown or black streaks on the surface of the nail |
| Symptoms | Discoloration, streaks, separation from the nail bed, bleeding, pain at the nail bed |
| Risk Factors | Age (50-70 years), darker skin tone, race (African-American, Asian, Hispanic) |
| Diagnosis | Biopsy of the nail matrix and nail bed, physical examination |
| Treatment | Surgery (removal of the nail and growth), amputation (debatable) |
| Prognosis | Positive with early treatment, 5-year survival rate: 15-20%, 10-year survival rate: 10-15% |
| Prevention | N/A |
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What You'll Learn
Subungual melanoma symptoms
Subungual melanoma is a rare type of skin cancer that occurs under the nails. It is a subtype of cutaneous malignant melanoma that arises from structures within the nail apparatus. It is not related to sun exposure, unlike other types of melanoma. Subungual melanoma is most common in non-White racial groups, with both men and women having an equal risk of developing it. It is the most common variant of malignant melanoma among African Americans, Asians, and Hispanics.
The key to the diagnosis and early treatment of subungual melanoma is awareness. It is important to learn how to spot the warning signs of nail melanoma to get treatment as soon as possible. The most common symptom of subungual melanoma is a discolored line that appears on the nail. It is usually brown or black and runs from the top to the bottom of the nail. This streak or stripe may start small but can grow to cover the entire nail and extend to the cuticle. The discoloration can be irregular and be varying shades of blackish-brown. The line can also multiply or grow wider over time, especially at the bottom of the nail.
In some cases, subungual melanoma does not discolor the nail. Instead, a nodule (small, irregularly shaped growth) can develop and lift the nail, or other nail damage may occur. Other symptoms associated with subungual melanoma include changes to the nail itself, bleeding, and pain at the nail bed. Subungual melanoma can also resemble a hematoma, which is when blood gets trapped under the nail after an injury or from poorly fitting shoes. However, a bruise or hematoma will generally heal and move outward as the nail grows, while a streak caused by subungual melanoma will not heal or change positions.
If you notice any of the symptoms of subungual melanoma, you should promptly consult a trained medical provider. A physician will likely ask questions about the patient's symptoms and perform a physical examination. If subungual melanoma is suspected, a biopsy will be ordered, and a tissue sample will be collected from the affected nail to determine whether the cells are cancerous.
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Diagnosis and treatment
Subungual melanoma is a rare form of skin cancer that grows beneath the nail. It is a subtype of cutaneous malignant melanoma and is unrelated to sun exposure. It is often mistaken for a bruise or a fungal infection. Subungual melanoma usually appears as a brown or black streak on the nail, which may start small but can grow over time. It is important to note that not all cases of this condition cause pigmentation changes in the nail.
To diagnose subungual melanoma, a doctor will first conduct a physical examination of the fingernail and ask about any changes in the nail's appearance, relevant medical history, and possible triggers. Dermoscopy of the nail plate can aid in early clinical diagnosis and help rule out less serious conditions. If subungual melanoma is suspected, a biopsy of the nail matrix and nail bed will be performed. A punch biopsy is a common procedure where a small sample is taken to test for melanoma.
If melanoma is detected, the doctor may order additional tests to determine if the cancer has spread. Staging of the melanoma is based on the number of cancerous cells and the extent of their spread. Treatment options depend on the stage of the melanoma. Surgery is the only viable treatment for subungual melanoma. The doctor will remove the entire nail and the growth. Sentinel lymph node biopsy is offered to medically suitable candidates with intermediate-thickness melanomas and is considered for high-risk lesions.
The key to successful treatment is early detection. When detected early, subungual melanoma is quite treatable, and the outlook is positive. However, if left untreated, it can metastasize and spread to other parts of the body, including distant organs and the brain. The 5-year survival rate varies widely, ranging from 15% to 20% in stage IV melanoma to over 99% for early-stage melanomas that have not spread.
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Prognosis and survival rates
Subungual melanoma, or nail melanoma, is a distinct subtype of cutaneous malignant melanoma. It arises from structures within the nail apparatus and is not related to sun exposure. It is a rare condition, accounting for 0.7% to 3.5% of all melanomas worldwide, but it can be life-threatening if not detected and treated early.
The prognosis and survival rates for subungual melanoma depend on several factors, including the stage of the cancer, the thickness of the melanoma, and the success of early detection and treatment.
Stages of Subungual Melanoma
The stage of subungual melanoma is determined by how deeply the cancer has spread. The most advanced stage, Stage IV, indicates that the cancer has spread to other organs in the body.
Survival Rates
The 5-year survival rate for Stage IV subungual melanoma is about 15% to 20%, while the 10-year survival rate is about 10% to 15%. The outlook is better if the spread is limited to distant parts of the skin or lymph nodes rather than other organs, and if blood levels of lactate dehydrogenase (LDH) are normal.
Early Detection and Treatment
Early detection and treatment are crucial for improving prognosis and survival rates. Subungual melanoma often goes undetected because people are unaware of the warning signs. It typically appears as a dark brown or black streak on the nail, growing wider and longer over time.
The key to early detection is awareness and education. Healthcare professionals should routinely examine nails and maintain a high index of suspicion for any pigmented lesions. Patients should also be educated to examine their nails and skin for unusual changes and to seek medical advice if they notice any changes.
Once detected, early referral to a dermatologist for a biopsy is essential to confirm the diagnosis and determine the extent of the disease. Wide local excisions are recommended according to lesion depth, and sentinel lymph node biopsies may be offered to assess the spread to lymph nodes.
Risk Factors
While anyone can develop subungual melanoma, certain factors increase the risk. It is more common in people of African-American, Asian, or Hispanic descent, and those between 50 and 70 years old.
Prevention
To reduce the risk of subungual melanoma and improve prognosis, it is important to practice good hand and foot hygiene, inspect nails and nail beds regularly, and protect the skin from the sun by using sunscreen, wearing protective clothing, and wearing sunglasses.
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Risk factors
Subungual melanoma is a type of skin cancer that starts under the nails. It is a subtype of cutaneous malignant melanoma that arises from structures within the nail apparatus. It is often mistaken for a bruise or a fungal infection. Subungual melanoma is not caused by sun exposure, unlike other types of melanoma, making it difficult to prevent. However, it can lead to serious complications if left untreated.
Age and Race: Subungual melanoma is most common in individuals between the ages of 50 and 70. It is also more prevalent in people of non-White racial backgrounds, particularly those of African-American, Asian, or Hispanic descent.
Family History and Genetics: A personal or family history of melanoma or skin cancer can increase the risk of developing subungual melanoma. Certain genetic mutations and syndromes, such as CDKN2A mutations and dysplastic nevus syndrome, have been associated with an increased risk.
Nail Trauma or Injury: Subungual melanoma has been linked to nail trauma or injury. This could include physical injuries to the nail, such as blunt force or poorly fitting shoes, that may cause nail damage or bleeding under the nail.
Nail Structure and Pigmentation: Changes in nail structure, such as thickening, pitting, or the appearance of ridges, can be risk factors. Additionally, any unusual pigmentation or discolouration of the nail bed should be monitored. This includes the appearance of dark brown or black streaks, lines, or spots on the nail, which could indicate the presence of melanoma.
Exposure to Toxins: Exposure to certain toxins, such as arsenic or radiation, has been associated with an increased risk of developing melanoma, including subungual melanoma.
It is important to note that the presence of these risk factors does not necessarily mean that an individual will develop subungual melanoma. However, being aware of these factors and regularly examining the nails for any unusual changes can aid in early detection and improve treatment outcomes.
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Prevention and detection
Melanoma, the deadliest form of skin cancer, can develop under and around the fingernails and toenails. Although rare, it is important to check your nails for melanoma, as it is highly treatable when found early.
Prevention
It is hard to prevent subungual melanoma because it is not directly caused by the sun or harmful substances. However, healthcare providers advise being vigilant and regularly checking your nails for signs of discoloration or unusual damage.
Detection
The most common symptom of subungual melanoma is a discoloured line that appears on your nail. It usually appears as a brown or black band, often on the thumb or big toe, but it can show up on any nail. The discolouration can be irregular and be varying shades of blackish-brown. It may start small but can grow to cover the entire nail and extend to the cuticle. The line can also multiply or grow wider over time, with the widening occurring at the bottom of the nail first.
In some cases, discolouration of the nail does not occur. Instead, a nodule (small, irregularly shaped growth) can develop and lift your nail, or other nail damage may occur. Other signs to look out for include dark skin next to your nail, nail splitting, and a bump or nodule under your nails.
If you notice any unusual changes to your nails, it is important to make an appointment with a dermatologist.
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Frequently asked questions
Subungual melanoma is a type of skin cancer that starts under the nails. It is a subtype of cutaneous malignant melanoma that arises from structures within the nail apparatus.
The most common symptom of subungual melanoma is a discoloured line that appears on the nail. It is usually brown or black and runs from the bottom of the nail to the top. The streak may start small but can grow to cover the entire nail and extend to the cuticle.
Subungual melanoma is treated surgically. A doctor will first remove the entire nail and then remove the growth. Surgery is currently the only viable treatment method for this type of melanoma.
Subungual melanoma is rare and accounts for 0.7% to 3.5% of all melanomas worldwide. It is most common in non-White racial groups, with people of African-American, Asian or Hispanic descent at higher risk.
