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How To Treat Melanoma Under Toenail

What Is The Prognosis Of Melanoma Of Nail Unit

How to tell a bruise under the toenail from toenail fungus
  • Individuals with early-stage Melanoma of Nail Unit, have better outcomes compared to those with more advanced melanoma, where the cancer has spread to lymph nodes or other organs
  • Multiple studies have shown that the overall 5 year survival rate for this melanoma type is between 16 to 87%
  • In general, the prognosis depends upon a set of several factors, which include:
  • Stage of tumor: With lower-stage tumors, when the melanoma is confined to site of origin, the prognosis is usually excellent with appropriate therapy. In higher-stage cancers, such as those with metastasis, the prognosis is poor
  • Overall health of the individual: Individuals with overall excellent health have better prognosis compared with those with poor health
  • Age of the individual: Older individuals generally have poorer prognosis than younger individuals
  • The size of the melanoma: Individuals with small-sized melanomas fare better than those with large-sized ones
  • Individuals with bulky disease have a poorer prognosis
  • Involvement of vital organs may complicate the condition
  • The surgical respectability of Melanoma of Nail Unit
  • Whether the cancer is occurring for the first time, or is recurrent. Recurring cancers have worse prognosis compared to those that do not recur
  • Response to treatment: Melanomas that respond well to treatment have better prognosis compared to melanomas that do not respond to treatment
  • Progression of the condition makes the outcome worse

How To Get Rid Of Toenail Fungus

All treatments can take up to a year to work, so you need to be consistent and commit to following the treatment plan for the long haul.

These infections are hard to treat because its difficult for medications to get into the keratin that makes up nails and the blood vessels dont connect to the nail. Many people find it hard to continue to use the medications for as long as is needed and may give up after months or even weeks.

Sometimes the nail will start to look better, but the fungus is still there. Your toenail fungus isnt cured until your doctor cant detect the fungus in your toenail clippings.

Pro Tip

There are a lot of folk remedies and over-the-counter topical treatments, but if you really want to get rid of this infection, youre probably going to need to take oral medication. Dr. Jacobsen

Health & Wellness7 Nail Symptoms Explained: Signs You Shouldn’t Ignore

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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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

What About White Streaks On Your Nails

Black Toenail Cancer: Things You Must Know

Another possible symptom to be aware of is noticing a white streak on your nails. Some people do have white marks on their nails, but this is usually due to some sort of damage that you may have done to it. ;It is also more probable that any white marks or ridges on your nails are due to vitamin deficiency.

However, if you notice these white streaks, where you are certain you have not caused them through any other means, it is important to seek advice from your doctor as soon as possible.

It could also be a sign of toenail fungus or an infection.

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Treating Black Nails Caused By Injury

  • 1Look for signs of toenail injury. Consider whether your toe was recently injured in some way. Injury to the nail bed can cause blood to accumulate under the nail, creating a black or dark brown discoloration. This is called a subungual hematoma. You may also experience symptoms such as a feeling of pain or pressure under the nail.XResearch source
  • In some cases, it may be obvious that your black toenail was caused by an injuryfor example, you may have dropped something on your foot or stubbed your toe.
  • Black toenails can also develop gradually from repeated injury, such as pressure from overly tight shoes or trauma to the toes caused by frequent running, hiking, or sports.
  • 2Use the RICE protocol to treat your nail at home. If your hematoma is minor and not causing you a lot of pain, you can likely manage it at home without medical help. Use Rest, Ice, Compression and Elevation immediately after an injury to minimize swelling and pain and encourage your toenail to heal:XResearch source
  • Rest: Rest the nail by minimizing the use of the injured foot as much as you can. For example, avoid running or hiking for a couple of weeks after the injury.
  • Ice: Put an ice pack wrapped in cloth or plastic wrap on the injured toe to numb the pain and reduce swelling. You can safely use an ice pack up to once an hour, for 20-30 minutes at a time.XResearch source
  • Ask your doctor before using aspirin or products containing aspirin, since these could make any bleeding under the nail worse.
  • What To Know About Nail Melanoma

    Melanoma on the extremities nails, hands and feet is the rarest subtype of the skin cancer, accounting for less than 5% of all melanomas, Patel said. But it makes up about a third of all the melanomas that African Americans, Indians, Asians and other people with darker skin develop, which is a ten-fold increase compared to the general population, he noted.

    This type of cancer called acral lentiginous melanoma tends to be more aggressive than other melanomas. It killed reggae legend Bob Marley at 36 after it showed up as a dark spot under his toenail.

    The main symptom is melanonychia, or a pigmented vertical streak on the nail. Some people have likened it to a line drawn by a Sharpie. That doesnt mean it’s always automatically worrisome because such streaks are much more common in patients with darker skin, Patel noted.

    When you have multiple, its reassuring because that may be a signature of your nail beds, he said.

    But if a vertical stripe suddenly appears on a nail or its changing, thats something a doctor should check out. Pigment extending from the nail portion onto the cuticle and nearby skin, which is called a Hutchinson’s sign, is also of concern.

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    Conditions That May Look Like Toenail Fungus

    Several health conditions can affect the appearance of your toenails and may be mistaken for toenail fungus.

    Psoriasis;Psoriasis;can cause red, scaly patches on the skin. More than half of people with skin psoriasis also have it on their nails. Toenails and fingernails affected by psoriasis may be thick, discolored, crumbly, or loose. Some people will have nail changes with psoriasis, and if it affects the matrix , then these changes are permanent, says Sheth.

    Skin Cancer;A discolored spot underneath a toenail may be a sign of melanoma, a potentially fatal form of;skin cancer. Melanoma under a toenail usually looks like a brown or black streak or may appear similar to a bruise. Although this isnt common, its also not rare, says Sheth. Her advice: Its always good to check it out.

    Darier Disease;This genetic disorder typically causes yellowish, wartlike blemishes on the body. However, some people with Darier disease also have fingernail or toenail irregularities, such as nails that are marked with red and white streaks, according to Genetics Home Reference. Sheth notes, however, that shes never had a biopsy come back with a diagnosis of Darier disease.

    The Black Line On Toenail Fungus

    Subungual Melanoma: What You Need to Know

    A black line on the toenail fungus is called melanonychia.

    This means that you have brown or black lines on your toenails.

    A black line associated with toenail fungus might be melanoma, but this is usually unlikely.

    If the black line extends into your skin, this is called a Hutchinson sign. A Hutchinson sign is much more likely to signal toenail cancer or toenail melanoma relating to your black toenail fungus. This might be something called subungual melanoma.

    Black toenail cancer, such as subungual melanoma, is sporadic. Personally, in our clinic, we have seen thousands of black toenails and black lines on toenails. Between all those cases, we have rarely seen toenail melanoma.

    But there are cases where we do perform biopsies if the toenail does appear suspicious. A toenail biopsy with a podiatrist can be one of the most effective ways to confirm no melanoma underneath the toenail.

    It is essential to always check with your podiatrist and get a biopsy if you are worried about melanoma.

    There is no 100% foolproof method to ensure that there is no melanoma underneath her toenail.

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    The Tragedy Of Bob Marley

    Robert Nesta Marley, famous Jamaican singer, and songwriter had an untimely death at the ripe at of 36. Hes known for hits like Natural Mystic, War, Redemption Song, and Iron Lion Zion, and Ganja Gun. The reggae pioneering icon tragically lost his four year battle with melanoma in 1981. Stereotypically, you wouldnt associate someone from Jamaica as one whod contract melanoma. It began under the toenail, and against doctors advice for amputation on the grounds of religious concerns, he opted for a toenail removal and skin graph.

    He continued touring and was planning a world tour as no disease could deter him from performing. He tried alternative treatments at a clinic run by Issel in Bavaria but died when it spread to his lungs. While the death of this treasured musician is a devastating reminder that no complexion is immune, he remands a legend in the music industry and will be continued to be remembered more for his work as an artist than unfortunate passing. His last words were spoken to Ziggy, his son, with his final breath of wisdom. Money cant buy life.

    What Is The Outlook For Patients With Melanoma Affecting The Nail Unit

    The main factor associated with the risk of spread of melanoma and death is the thickness of the melanoma at the time of complete excision of the primary tumour. Delay in diagnosis is common with subungual melanoma, particularly when it affects the toe, and some of these tumours have already spread at the time of diagnosis.

    The 5-year survival rate ranges widely from 16% to 87%, depending on the series, with two larger series in the 51% to 55% range;.

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    Cancer Treatments And Nail Health

    Certain cancer drugs may also cause nails to change color or texture. The American Cancer Society lists the following nail changes that may result from certain chemotherapy or targeted therapy;drugs:

    • Dark areas in the cuticle
    • Darkening of the nails, known as hyperpigmentation
    • Deep grooves known as fissures
    • Tiny red or brown lines that grow in the same direction as the nail
    • Nail loss

    Does Toenail Fungus Turn Black After It Dies

    Hutchinson Sign Nail Melanoma

    Yes, a detached toenail can turn black after it dies.

    • The most common pathway for this to happen is for fungus to an infected toenail. The toenail then can start to rip away from the toe after it gets thick and black.
    • This can cause dry blood to form between the toenail and the skin, and eventually, the toenail dies.
    • The toenail then starts to rot and become overrun by bacteria and toenail fungus.
    • This eventually can make toenail fungus turn black after it dies.

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    Is A Toenail Melanoma Rare

    The current lifetime risk for having a toenail melanoma is 1 in 120 for men and 1 in 95 for women. ;Therefore, it can be classed as an uncommon type of cancer. Other statistics show that it only accounts for 0.7% and 3.5% of all melanoma cases.

    Some research published in 2010 revealed that in the UK, there were over 8500 new cases treated per year.

    There is a 60% chance that they will occur in the fingernails, compared to 40% in the toes. ;Your thumbs and big-toes are the most common digits to be affected.

    They are also more common in older people, between the ages of 50 to 70 years old.

    What Should You Do

    If you suspect that you have a nail melanoma, the first advice is not to panic. The possibility that the mole or mark is cancerous is quite low and the sooner you take action to investigate it, the better.

    Start by making a note of the location and size of the spot taking photographs is a good way to do this. If, whilst you are monitoring it over a few days, you can see that the spot has grown in size or changed color, there is a higher chance that it could be a melanoma.

    The next step will be to make an appointment with your doctor and present your findings to them, asking for a referral to check if this spot is turning into a melanoma.

    It is likely that, in the absence of any other possible cause for the discoloration or mark, that you will be sent for a biopsy to confirm its status.


    If you notice any of these signs and symptoms, it is important that you make an appointment with a doctor as soon as possible. To put it bluntly, these melanomas are often non-cancerous but they are cancer and are best investigated and treated as early as possible.

    Early detection will increase the recovery rate and will put your mind at rest more quickly. Because a toenail melanoma is a type of cancer, it is also highly likely that a follow-up course of chemotherapy and radiation treatment will be completed.

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    Enhancing Healthcare Team Outcomes

    Subungual melanoma is most common in non-Caucasians, with both men and women having equal risk. Like other forms of melanoma, subungual melanoma can also spread to other parts of the body and is lethal. The key to diagnosis and early treatment is awareness. All healthcare workers, including nurses, should routinely examine the nails and maintain a high index of suspicion for any pigmented lesion on the nails. The only way to reduce the high mortality is an early referral to a dermatologist for a biopsy. Further, the nurse should educate patients on examining their skin and nails for unusual changes. Finally, both the nurse and the pharmacist should educate the public about using sunscreen when going outdoors and wearing protective clothing when going outdoors. Sunglasses are also recommended as the UV rays of the sun can damage the retinal cells.


    For early lesions, the outcomes are good, but for advanced lesions, the outcomes are poor. Disease-free survival is not affected by the type of surgery on the nail. The earlier the diagnosis, the better the survival.

    What Are The Signs And Symptoms Of Nail Cancer

    Toe Punch Biopsy to Test for Malignant Melanoma | Auburn Medical Group

    Subungual melanomas usually appear as darkened spots that run longitudinally on the toenail bed. They can be brown, blue, or black in color. Some may even lack color .

    A key indication of subungual melanoma is the extension of the black spot or streak from the top of the toenail down to the toenail bed and into the cuticle.

    Other signs include:

    Brown or black mark in the toenail without any known injury or cause Brown or black mark on the nail that increases in size A bruise on the nail that will not heal Toenail that separates from its nail bed Darkening skin around the nail Cracking or distortion of the nail Bleeding around the nail

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    Symptoms Of Melanoma Fingernail

    Melanoma has this connotation as a mole or raised freckle, however, this is not the case with fingernail melanoma. It can appear as a dark, vertical line and wont present any painful lesions or sensitive areas until it progresses.

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    Spotting it early on is key, but it can easily be misidentified as something else. It spreads fast and the window where you have to act is rather small.


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