Ava Monroe
Subungual melanoma, also known as nail unit melanoma, is a rare type of skin cancer that develops under the nails. It is a deadly form of skin cancer that can spread to other organs if not detected and treated early. It is caused by increased melanin production by the melanocytes, which are responsible for producing melanin (skin pigment). Subungual melanoma usually appears as a brown or black streak under the nail and can grow over time. It may take several months for nail melanoma to grow and can be challenging to identify as it may resemble bruising of the nails. Diagnosis of subungual melanoma involves a physical examination of the nail, reviewing medical history, and performing a biopsy for histopathologic examination.
| Characteristics | Values |
|---|---|
| Type of cancer | Skin cancer |
| Affected area | Under and around the fingernails and toenails |
| Common symptoms | Dark brown or black streaks, colour changes, bruise under the nail, nail separating from the nail bed, nail splitting, bump or nodule under the nails |
| Occurrence | Rare |
| Diagnosis | Dermoscopy, biopsy |
| Treatment | Surgical removal of the affected area, radiation therapy, chemotherapy, immunotherapy |
| Preventive measures | Regularly check nails for changes |
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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. Unlike cutaneous malignant melanoma, subungual melanoma does not appear to be related to sun exposure. It originates from activation and proliferation of melanin-producing melanocytes of the nail matrix.
- Dark brown or black streaks on the surface of the nail, which may start small but can grow to cover the entire nail and extend to the cuticle. These streaks may be irregular and can be varying shades of blackish brown.
- Changes in colour in or around the nail, including irregular pigmentation.
- Bruise under the nail that does not heal.
- Nails separating from the nail bed.
- Thinning, cracking, or distortion of the nail plate.
- Pain and inflammation.
If you notice any of these symptoms, it is important to consult a trained medical provider promptly. A doctor will typically perform a physical examination and ask about the patient's symptoms and medical history. If subungual melanoma is suspected, a biopsy may be ordered to confirm the diagnosis.
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Melanoma diagnosis
Melanoma is a type of skin cancer. It usually appears as a brown or black discolouration of the nail bed, often in the form of a streak or stripe. This discolouration can progress to thickening, splitting, or destruction of the nail, with pain and inflammation. It is important to note that melanoma can also present without any nail discolouration; instead, a nodule (small, irregularly shaped growth) can develop and lift the nail, or other nail damage may occur.
Melanoma of the nail unit is typically a variant of acral lentiginous melanoma, which originates from the palms and soles of the feet. It most frequently affects the thumbnail and the great toe, accounting for 75-90% of cases, although any nail can be affected. This type of melanoma is rare, accounting for 0.7-3.5% of malignant melanomas in white-skinned individuals and up to 75% in dark-skinned and Asian populations. It is important to note that melanoma of the nail unit does not appear to be related to sun exposure.
If you notice any suspicious changes to your nails, such as discolouration or nail damage, it is crucial to consult a healthcare provider. Your healthcare provider will examine your nail and review your medical history to determine if you are at high risk for subungual melanoma. They may perform a dermoscopy, using a special microscope called a dermascope, or a biopsy to confirm the diagnosis.
A biopsy is a procedure where a small sample of tissue is removed and sent to a laboratory for analysis under a microscope. There are different types of biopsies, such as shave biopsy, punch biopsy, and excisional biopsy, and the doctor will choose the most appropriate method based on the size and location of the affected area. The biopsy should remove as much of the suspected area as possible to ensure an accurate diagnosis. Local anaesthesia is typically used to numb the area during the procedure.
After a melanoma diagnosis, further tests may be conducted to determine the extent of the disease and guide treatment decisions. These tests may include imaging scans, such as CT scans, to detect the spread of cancer to other parts of the body, including nearby lymph nodes, lungs, or the brain. It is important to seek medical attention promptly if you suspect melanoma to increase the chances of successful treatment.
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Melanoma treatment
Melanoma is a type of skin cancer that can occur under the nail, known as subungual melanoma. This type of melanoma is a distinct subtype of cutaneous malignant melanoma and arises from structures within the nail apparatus. Subungual melanoma is not related to sun exposure, unlike other forms of melanoma. It is usually a variant of acral lentiginous melanoma, which originates on the palms and soles. It can also be caused by injury or trauma and is most prevalent in the big toe and thumbnail.
Subungual melanoma usually presents as a brown-black discolouration of the nail bed, appearing as a streak or stripe that runs from the bottom to the top of the nail. This discolouration can become wider and more irregular over time and may extend to the cuticle. In some cases, subungual melanoma may not cause nail discolouration but can lead to the development of a nodule or other nail damage. It is important to note that subungual melanoma grows slowly over several months, and early detection is crucial for successful treatment.
If you suspect you have subungual melanoma, it is important to consult a healthcare provider for an accurate diagnosis. They will examine your nail, review your medical history, and assess your risk factors. They may perform a dermoscopy, using a special microscope called a dermascope, or a biopsy to analyse the tissue for cancerous cells.
Treatment options for melanoma will depend on the stage of the cancer and other factors. Early-stage melanomas can often be treated with surgery alone, while more advanced cancers may require additional treatments. These treatments may include chemotherapy, immunotherapy, or targeted therapy. It is important to discuss all treatment options and their potential side effects with your healthcare team to make an informed decision. Complementary and alternative treatments may also be considered, but it is important to approach these with caution as many have not been proven effective and some may interfere with standard medical treatments.
Additionally, support services can play a crucial role in your care during melanoma treatment. These may include nursing or social work services, financial aid, nutritional advice, rehabilitation, or spiritual support. It is also recommended to seek a second opinion to gain more information and confidence in your treatment plan.
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Melanoma risk factors
Melanoma is a type of skin cancer that can occur under your nail or on your skin. It is important to be aware of the risk factors for melanoma as it may help you lower your risk of getting it. While having risk factors does not guarantee that you will develop melanoma, they can increase the likelihood of developing the disease. Here are some risk factors for melanoma:
Ultraviolet (UV) Radiation Exposure
Ultraviolet radiation from the sun or sunbeds is a significant risk factor for melanoma. Excessive UV exposure can increase the risk of developing melanoma, especially if it leads to frequent sunburns. In the UK, about 85% of melanomas are attributed to excessive UV radiation exposure. However, it is important to note that melanoma of the nail unit may not be directly related to sun exposure.
Family History and Genetics
If you have a family history of melanoma, your risk may be higher. This could be due to shared genetic factors, a tendency for lighter skin tone, or shared lifestyle factors such as frequent sun exposure. Certain gene mutations that run in families can increase the risk of melanoma. Dysplastic nevus syndrome, also known as atypical mole syndrome, is an inherited condition where individuals have a high lifetime risk of developing melanoma.
Skin Type and Moles
Your skin type and the presence of moles can also influence your risk. Melanoma is more prevalent in individuals with lighter skin tones. Additionally, having many irregular or large moles increases the risk of melanoma. Moles present at birth, known as congenital melanocytic nevi, can carry a higher risk, especially if they cover large portions of the body. The risk associated with congenital nevi depends on their size, location, and colour.
Age
The risk of developing melanoma increases with age. Older individuals are generally at a higher risk compared to younger people. However, compared to other cancer types, melanoma is also relatively common in younger age groups.
Occupational Hazards
There is limited evidence suggesting a link between working as a firefighter or in the petrol refining industry and an increased risk of melanoma. Exposure to harmful chemicals and other occupational hazards may play a role, but further research is needed to confirm these associations.
It is important to note that while these are risk factors, the presence or absence of any single factor does not guarantee the development of melanoma. Additionally, some risk factors, such as UV exposure and lifestyle choices, can be mitigated to lower your overall risk. If you notice any changes to your nails or skin, it is always best to consult a healthcare professional for a thorough examination and diagnosis.
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Melanoma types
Melanoma is a type of skin cancer that can grow into and destroy nearby tissue and spread to other parts of the body. It starts in cells called melanocytes, which produce melanin. There are four main types of melanoma:
Superficial Spreading Melanoma
Superficial spreading melanoma is the most common type of melanoma, accounting for about 70% of cases. It typically grows along the top layer of the skin and can spread across the surface of the skin before growing deeper into the skin. It often appears as a thin, flat lesion with an uneven border and can vary in colour, including shades of red, blue, brown, black, grey, and white. It usually develops on the trunk, arms, and legs.
Nodular Melanoma
Nodular melanoma is the second most common type, accounting for about 15-20% of cases. It tends to grow aggressively and quickly downward into the deeper layers of the skin. It typically appears as a bump or node that is firm to the touch and may be black, red, pink, or skin-coloured. Nodular melanoma usually develops on the face, chest, or back, including areas not exposed to the sun.
Lentigo Maligna Melanoma
Lentigo maligna melanoma accounts for about 10-15% of cases and typically develops in older individuals. It often appears as a large, flat tan or brown patch with an uneven border that tends to darken as it grows, exhibiting various shades of brown or black. It usually develops on the face, scalp, or neck.
Acral Lentiginous Melanoma
Acral lentiginous melanoma is a rare type of melanoma, accounting for only 1-3% of cases. It typically develops on the palms of the hands, soles of the feet, or under the nails. It is more common in individuals with brown or black skin. This type of melanoma can be challenging to diagnose due to the difficulty in detecting abnormal areas on the soles of the feet or under the nails.
Other less common types of melanoma include:
- Subungual melanoma, which arises from structures within the nail apparatus and is not related to sun exposure.
- Mucosal melanoma, which develops in the mucous membranes lining the head and neck region, anus, vagina, and gastrointestinal tract.
- Intraocular melanoma, which starts in the eye and is the most common type of eye cancer.
- Choroidal melanoma, which begins in the pigmented layer beneath the retina.
- Conjunctival melanoma, which originates in the clear conjunctiva covering the eye's surface and inside of the eyelids.
- Iris melanoma, which starts in the eye's middle layer, including the coloured iris surrounding the pupil.
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Frequently asked questions
Subungual melanoma appears as a brown or black streak under the affected nail. It usually starts as a narrow band, visible on the length of a single nail plate, and grows wider over time.
It can take several months for subungual melanoma to grow. It is not something that develops overnight. You may notice it, then forget about it before noticing it again several weeks later.
To diagnose subungual melanoma, a doctor will first conduct a physical assessment of the nail. They may ask about the history of symptoms and whether the patient has any relevant medical history. If the doctor suspects subungual melanoma, they will order a biopsy to confirm the diagnosis.
Treatment for subungual melanoma typically involves surgically removing the affected portion of the nail and/or digit. This may be accompanied by radiation therapy, chemotherapy, and/or immunotherapy to prevent or treat the spread of cancer to other areas of the body.
