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How To Treat Melanoma In Nails

How Is Melanoma Of Nail Unit Treated

Subungual Melanoma: What You Need to Know

The choice of treatment for Melanoma of Nail Unit depends on how far the cancer has progressed. This is estimated through staging of the melanoma. Some of the factors taken into consideration during staging include:

  • The thickness of the melanoma : Tumors can be thin, intermediate, or thick, depending on how deep into the skin they have penetrated. The thinner the tumor, the better the chances of a cure
  • Presence of any ulceration over the tumor
  • Spread of melanoma to lymph nodes or other internal organs

The melanoma is sorted into one of four stages depending on how far it has progressed, with I and II being early stages, III and IV being later stages, where melanoma has spread to sites beyond the skin. While early stage melanomas can be treated by surgery alone, the later stages of the disease often require a combination of treatment measures.

Treatment options for melanoma include:


  • Simple excision of the tumor along with some normal, non-cancerous skin at the edges . The width of the margin is based on the thickness of the tumor; as the thickness of the melanoma increases, the margin required increases as well
  • Mohs micrographic surgery:
  • Being used of late by some surgeons as an alternative technique to standard excision of melanoma
  • A thin layer of skin is removed and checked for cancer. This process is the carried out continuously, until a cancer-free slice of skin is obtained
  • This procedure is rarely used as a surgical treatment option for melanoma


Overview And Scope Of The Guidelines

Melanoma is a life threatening but potentially treatable form of cancer if diagnosed and managed at an early stage. Guidelines have been published to assist healthcare workers in the recognition of malignant melanoma of the skin . However, early melanoma arising on the foot, particularly within the nail unit and on the plantar surface, can be difficult to recognise. Consequently, this can lead to delays in diagnosis. Melanoma arising on the foot carries a particularly poor prognosis when compared to melanoma arising at other body sites . As there are no consistent features of an early melanoma, these guidelines have been drafted to alert health care workers to the signs which may suggest melanoma and therefore warrant a specialist referral. A melanoma recognised and diagnosed at an early stage can dramatically increase a patient’s chances of survival.

What Are The Treatment Options Of Subungual Melanoma

Cancers are not curable by medications alone, and you will need to completely get rid of the cancerous cells in order to treat it. Since these melanomas affect the areas under your nails, surgical intervention is required to remove the affected toenails first before removing the cancerous cells beneath your nails.

Today, this same surgical intervention is still the only effective method to treat melanomas on nails. Usually, after the surgery, you will no longer need to worry about the affected cancerous cells.

Depending on how early you have your subungual melanoma diagnosed, your survival rate for the next 5 years ranges between 16 18%. The earlier you diagnose it, the better!

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How Do Dermatologists Diagnose Melanoma

When you see a board-certified dermatologist, your dermatologist will:

  • Examine your skin carefully

  • Ask questions about your health, medications, and symptoms

  • Want to know if melanoma runs in your family

If any spot on your skin looks like skin cancer, your dermatologist will first numb the area and then remove all of it. This can be done during an office visit and is called a skin biopsy. This is a simple procedure, which a dermatologist can quickly, safely, and easily perform.

Having a skin biopsy is the only way to know for sure whether you have skin cancer.

The tissue that your dermatologist removes will be sent to a lab, where a doctor, such as a dermatopathologist, will examine it under a high-powered microscope. The doctor is looking for cancer cells.

What this doctor sees while looking at your tissue will be explained in the pathology report, including whether cancer cells were seen. If melanoma cells are seen, the report will include many important details, including:

  • The type of melanoma

  • How deeply the melanoma tumor has grown into the skin

  • How quickly the melanoma cells are growing and dividing

If its possible to tell the stage of the melanoma, the report will include this information.

Stages of melanoma

Heres an explanation of what each stage of melanoma means:

Stages of melanoma

Stage 0

The melanoma has spread to either: One or more nearby lymph node Nearby skin

Once the stage is known, the next step is treatment.

What Is A Subungal Melanoma

Subungual hematoma: Symptoms, causes, and treatment

The term subungal just means under the nail and is often used to describe a mark or problem that appears below the nail surface.

There are 3 main classifications or types for this disease that refer to the location of the melanoma:

  • Subungal the issue is found in the nail bed or matrix and is under the nail.
  • Ungual the melanoma grows from underneath the nail plate.
  • Periungual where the melanoma is found on the skin surrounding the edges of the toenail.

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What Is Melanoma Of Nail Unit

  • A melanoma is a type of cancer that develops from cells, called melanocytes. Melanocytes are cells that produce melanin; the pigment that gives skin its color
  • Melanomas that are confined to the epidermis and have not yet penetrated through the basement membrane are called melanoma in situ. Melanomas that have spread to areas beyond the skin from its site of origin are called metastatic melanomas
  • Melanoma of Nail Unit is a melanoma that affects the nail – either the fingernail or the toenail. It may affect the nail bed or nail sides and is capable of spreading to other parts of the body. Frequently, the big toe or the thumb is involved
  • There are 3 main types of Nail Unit Melanoma and these include:
  • Subungual Melanoma
  • Periungual Melanoma
  • In general, there are 4 basic types of melanomas which include:
  • Superficial spreading melanoma: It is a common type of melanoma that arises from a benign mole. It can slowly appear to spread with change in pigmentation, but is capable of a rapid progression
  • Lentigo maligna melanoma: It is a less common type that is seen during middle-age or older age. The condition usually affects the face and may resemble sunspots
  • Acral lentiginous melanoma: This type may occur at any location on the body, including the hands, feet, and below the nails. It is the least common type
  • Nodular melanoma: It is the most aggressive melanoma type usually affecting adult males
  • Melanonychia As A Result Of Drug Treatments

    A few drug treatments might stimulate nail matrix melanocytes to create melanin, producing a band of melanonychia varying in shade from light brown to black color. In drug caused melanonychia, a few nails are typically impacted with several straps. Drug caused melanonychia most typically presents itself four to eight weeks after drug usage. Pigmentation is generally reversible within a matter of weeks however can continue to persist for several months.

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    Being Aware Of Melanoma Under The Toenail

    The fingernails are more apparent to you as you check them more often and are more conscious of injuries that befall them and so on. They are also easier to see in comparison to the nails on your feet. Be careful and cautious to check your toes every once in a while as melanoma under your toenail may be easily hidden by poorly applied nail polish or you may mistake it for being a bruise from slamming it into your nightstand.

    Bacterial Infection Of The Nail

    Melanoma on Your Nail?

    The Staphylococcus aureus bacterium is a common cause of bacterial infection of the nail. Typically, the infection first takes hold in the fold of skin at the base of the nail . Without treatment, the infection can worsen, leading to inflammation and pus. It is often associated with candida infection, particularly when it becomes chronic.Activities that predispose a person to a bacterial nail infection include:

    • Having constantly wet hands
    • Overzealous attention to the cuticles
    • Severe nail biting, which can expose underlying tissues to infection
    • Eczema around the fingernails.

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    Symptoms Of Melanoma In Nails: Causes And How To Treat It

    Melanoma of nail is nail cancer. It is a cancer that develops from the melanocyte cells present in the skin. Melanocytes produce melanin pigment that gives color to our skin. Melanomas are usually confined to the upper layer of skin. But sometimes they may spread to other parts from its basic site. This type of melanoma is called metastatic melanoma.

    Melanoma of nail can develop on finger nail or toe nail, mostly the thumb nail or the toe nail. Melanoma of nail can be present on nail bed or may appear at the side of nail.

    Melanoma usually develops in light skinned people, but acral lentiginous form is seen more in dark skinned individuals. Once diagnosed the treatment of choice is complete surgical removal of the melanoma. Additionally chemotherapy and other modes of treatment may be needed. Prognosis may depend on the severity and it is good if the condition is detected in its early stage. Advanced melanoma of nail has bad prognosis.

    When To See A Foot Specialist

    Lesions that occur on the nail unit or the soles of the feet need to be watched carefully for malignant transformation .

    The bottom line -; if you have a pigmented streak or spot, on your toenail, underneath your toenail or on the nail fold beside your toenail, no matter what the color, you should have it evaluated by a specialist.; Little spots on little toenails could be signs of a big problem.

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    Prevention And Early Detection

    The exact cause of subungual melanoma is unknown, meaning that patients cannot take specific steps to prevent this condition. However, because it may be associated with trauma to the hands and feet, you may want to keep yours hands and feet protected.2 For example, you can protect your hands and feet by wearing gloves during heavy labor, or wearing protective gear and sturdy shoes during sports.

    Early detection is crucial to the treatment of subungual melanoma, so be sure to tell your doctor about any changes to your nails.1 You can regularly check your nails, fingers, and toes for any bruising, streaking, or changes.3

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    Some doctors say nail melanoma often develops on the thumb of ones dominant hand, or big toe of ones dominant side, but Patel has seen it on all digits and believes all of the nails are equally potentially affected.

    This type of melanoma is more driven by genetics and family history than sun exposure, but people should still follow sun-safe practices, he added:

    • Be careful about UV exposure, including at the nail salon. Wear fingerless gloves with an ultraviolet protection factor or apply sunscreen to your hands at least 15 minutes before a gel manicure.
    • When outside, apply sunscreen to the whole body, including around your nails and on your hands.
    • Wear sunscreen and possibly gloves during your daily commute: If youre a driver who has your hands out in a one-and-a-half-hour commute, youre getting UV radiation exposure right to the backs of the hands and the nails, Patel said. Some of these things sound crazy, but the cumulative exposure over time .
    • Remove nail polish before going to your annual skin check so a doctor can see your nails.

    With Jasko’s family history of melanoma, doctors cant say how much of a role her regular UV exposure at the nail salon played. She now paints her nails with regular polish and skips the gel manicures. She also gets her skin checked every four months and is doing well.

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    Causes Of Nail Fungus

    With fungal nail infections, the main cause is typically

    • molds
    • dermatophyte

    Certain behaviors and preexisting conditions that can affect your risk of nail fungus include:

    • old age

    There are many overlaps between nail fungus and nail cancer. Since its easy to mistake cancer of the nail for a fungal infection, you should see a doctor immediately to get a definitive diagnosis.

    See a doctor immediately if you suspect you have toenail fungus or subungual melanoma.

    Since the prognosis of subungual melanoma gets worse the longer it takes to diagnose, its better to be safe and get any possible symptoms checked out and cleared as soon as they appear.

    Fungal infections are not considered life-threatening, but the 5-year survival rate for subungual melanoma can vary dramatically depending on how early the cancer is identified. According to the Canada Dermatology Association, chances of recovery can range anywhere from 16 to 80 percent .

    If you wait too long for diagnosis and treatment, theres a risk of the cancer spreading throughout the bodys organs and lymph nodes.

    How Are They Diagnosed

    Initially, the doctor may use the ACBDEF method to help identify if the marks you have are cancerous.

    Each letter represents a feature to consider as part of the diagnosis:

    • A The age of the patient is taken into consideration because if you are over 50, the risk of getting this is higher.
    • B Are there any bands and what color are they: Black or brown and are the borders of the bands blurred?
    • C Has the mark changed at all since it was noticed? ;Getting bigger or darker can be a symptom.
    • D Which digit is the mark affecting? ;It is mainly your big toe that is affected.
    • E Has the coloration made any extension to the surrounding area?
    • F Have your family had any history of cancer or specifically this type?

    If anything is suspected, a proper diagnosis is done by taking a small biopsy of the tissue from under the nail.

    This is done by punching or drilling through the nail and taking a sample from an affected area. ;It is done under local anaesthetic and does not take long to perform.

    The sample is then examined by a Dermatopathologist who will be able to make an informed diagnosis.

    This is not something you can diagnose yourself, so please see a doctor as soon as possible if you think you may have this problem.

    Getting early medical advice or intervention is very important. ;You might think that it is just a brown spot under your toenail, but it does mean that you need to seek some help.

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    Don’t Be Misdiagnosed Know The Signs Of Toenail Melanoma

    What You Should Expect For An Accurate Diagnosis and Effective Treatment For Subungual Melanoma

    A dark spot or streak on your toenail could be a sign of subungual melanoma.; It’s often slow and painless growth makes it tricky to catch early.; Learn the signs and when to seek urgent treatment.

    We suspect melanoma from a pigmented spot that starts at the bottom of the nail next to the cuticle and makes a black streak on the toenail as it grows out toward the tip of the toe.

    Sometimes you can have a discoloration of the nail fold at the proximal part of the nail and that discoloration of the skin is called a Hutchinson Sign.; Seeing Hutchinson Sign on your toenail is a good indicator that you may have a malignancy at the nail matrix.;;

    Melanoma of the nail unit usually affects the big toenail but any toenail;may be involved.

    • Sugungual melanoma orginates from the nail matrix
    • Ungual melanoma originates from under the nail plate
    • Periungual melanoma orginates from the skin beside the nail plate

    It’s often slow and painless growth make it tricky to catch.

    Presentation Of Melanoma In The Nail Unit


    There are 2 main patterns of nail unit melanoma ; longitudinal melanonychia and amelanotic tumours . The first may be associated with alteration of nail plate anatomy in more advanced cases. The latter is almost always associated with nail plate change. Some NUM may present with features common to both patterns.

    Figure 3

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    Things You Need To Know About Subungual Melanoma

    Melanoma is a type of cancer that forms within the melanocytes, which are the cells that produce your skin’s pigment. Any area of your skin can develop melanoma, including the skin beneath your toenails. Here are four things you need to know about subungual melanoma.

    What causes subungual melanoma?

    The cause of subungual melanoma is still poorly understood. While melanoma that develops on other areas of your skin is linked to ultraviolet radiation , this isn’t a likely cause of subungual melanoma. This is because it’s unlikely that sunlight will pass through your toenails and damage the skin underneath.

    A significant number of patients report direct trauma to the affected toenail before the onset of the melanoma, so it’s possible that trauma triggers the condition. However, more research is needed to prove that trauma is really a cause and not just a coincidental finding.

    What are the symptoms of subungual melanoma?

    Generally, subungual melanoma develops beneath the big toe, but it can sometimes affect your other toes. Its presentation can vary quite a bit. In some cases, it presents as band-like black discoloration on the affected nail, which later spreads. The entire nail may eventually turn completely black.

    In other cases, your nail bed will split or your nail will become deformed. Masses may also form beneath the nail. If you notice any changes in the appearance of your toenails, see your podiatrist.

    How does it differ from other melanomas?


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