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What Does Melanoma Look Like Under The Nail

Education And Advising Clients

Melanoma on Your Nail?

Despite efforts to educate the public about subungual melanoma in the last couple of decades, awareness of this type of cancer remains poor, noted the authors of a paper published in the Journal of the American Academy of Dermatology in 2018. This is why nail techs, who interact with people who might not see health care providers regularly, are a crucial piece of the detection puzzle, they wrote.

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.

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.

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Warning Signs Of Alm Include:

  • a new streak in a nail that is not caused by an accident or bruise
  • a nail streak that has damaged the fingernail
  • a changing spot in or connected to a mole on the foot or hand
  • an irregularly-shaped growth on the foot or hand that is changing, growing or has an unusual color
  • an elevated, thickened patch growing on the sole of the foot or palm of the hand

Toenail Melanoma Symptoms Causes And Treatments

Melanoma under the toenail?

If you have noticed a dark, bruised looking spot or brown streak under your toenail, keep an eye on it as it is possibly a melanoma.

These toenail melanomas are the same type that is found on any part of your skin, but they have grown underneath your nail. If you have spent many years wearing nail polish, or not taking too much notice of your toes, it is possible that you have missed such a symptom completely.

Because you dont always just sit, looking at your toenails all the time, the problem is caught later than it should be, which can increase any problems.

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Differences In Appearance Between Blood Under A Toenail And A Melanoma: Under More Scrutiny

Association with trauma. The trauma that leads to blood under a toenail isnt always blunt and painful at the time of occurrence.

It could be as seemingly innocuous as jogging downhill in footwear that isnt roomy enough. The patient might not even recall the trauma.

Though subungual hematoma often affects both big toes at the same time, it CAN occur in only one toe.

If your right foot is a little bigger than the left, the shoe on your right foot will have a tighter fit that may result in a hematoma, while the shoe on the left wont.

More than one toenail. If the appearance of the dark pigment in a big toe coincides with a similar-looking pigment in another toe either on that foot or the other then this points to a benign cause.

Blood grows out. If you view a hematoma every several days, youll notice that the space between the portion closest to the cuticle and the cuticle is getting bigger, or showing more nail.

As the nail is pushed out, the blood underneath goes with it. So if you noticed the pigment when it was first visibly connected to the cuticle area, in a few weeks it will be closer to the center of the nail, then after several more weeks itll be near the top of the nail. It can take several months to finally grow out.

Eventually the nail will be long enough such that when you trim it, youll also be trimming out the old dried blood.

A melanoma will stay firmly adhered to its place it will not move upward as the nail grows.

Amelanotic Tumour Of The Nail Unit

In conclusion, NUM is best detected early if all clinicians and patients have a low threshold for asking for advice early. In particular this means avoiding prolonged periods of conservative management of change in the nail or periungual tissues that are limited to one digit and do not respond promptly to appropriate treatment. For less advanced lesions, where there is only altered pigment, if such pigmentation is limited to a single digit and cannot confidently be attributed to a single episode of subungual bleeding then expert advice should be sought. In all instances, although general practitioners are a good source of general assessment, they typically do not have any experience of NUM. We would recommend assessment by a Dermatologist.

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Nail Melanoma Is Highly Treatable If Found Early Doctors Say

“When found early, melanomaeven on the nailsis highly treatable,” Souyoul said. The authors of the aforementioned 2016 Australian Family Physician study agree, noting that “detecting subungual melanoma at an early stage potentially has a great impact on a patient’s likelihood of cure.”

Souyoul says “the best way to find skin cancer on your nails early, when it’s most treatable, is to know what to look for and regularly check your nails.” The AAD has a helpful video that can guide you through the process of checking your nails for melanoma.

The good news is, the five-year survival rate for people who discover melanoma in its early stagesbefore it spreads to the lymph nodesis 92 percent, according to the AAD.

Yes Melanoma Can Affect A Fingernail Or Toenail And There Are Two Major Warning Signs That What You See Is A Potentially Deadly Tumor Also Known As Subungual Melanoma

Subungual Melanoma: What You Need to Know

Myths About Nail Melanoma

White people cant get it. Wrong, whites can get this disease, though its much more common in blacks and Asians.

Children cant get it. Wrong. There are cases of pediatric subungual melanoma.

Since it affects only the nail, its not that serious. Wrong. Like any other kind of melanoma, a tumor that affects the nail can penetrate and spread to other parts of the body via the lymphatic system.

Once this disease has spread to distant sites, prognosis is very poor.

Between one and two percent of all melanomas are the subungual type.

I routinely see patients in for streaks or dark spots in the nails, says Erum Ilyas, MD, a board certified dermatologist who performs adult and pediatric medical dermatology, cosmetic dermatology and skin cancer treatment with Schweiger Dermatology Group.

It goes without saying that if you google this one, you will undoubtedly see that this needs to be evaluated to rule out melanoma, says Dr. Ilyas.

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Melanoma Under Nails: A Stealthyand Dangerousform Of Skin Cancer

Skin cancer can occur anywhere on your skin, even places you wouldn’t necessarily consider “exposed.” Interestingly, this includes under your nails. Although far less common than areas such as the face, arms, and legs, melanoma under nails can be just as problematic as when situated elsewhere on the body and, in fact, can be especially risky, given that it’s often noticed and diagnosed later than it might be in more obvious areas.

Read on to learn more about this lesser-known skin cancer danger.

Look For The Signs Of Melanoma

When this skin cancer develops on a foot, you may see the ABCDEs of melanoma, but its also possible for a melanoma to have different features. Aside from looking like a changing mole, a melanoma on the foot can appear as a:

  • Brown or black vertical line under a toenail

  • Pinkish-red spot or growth

  • New spot or growth where you injured your foot

  • Rapidly growing mass on your foot, especially where you once injured your foot

  • Non-healing sore on your foot

  • Sore that looks like a diabetic ulcer

Sometimes, melanoma on the foot feels painful, bleeds, or itches, but not always. The bleeding tends to stop and start.

The following pictures show you what melanoma can look like on the foot.

Melanoma on the bottom of a toe

You can see some of the ABCDEs of melanoma. One half of this spot is unlike the other, it has an uneven border, and the color varies within the spot.

Melanoma on the bottom of a foot

Here, you can also see some of ABCDEs of melanoma, such as one half is unlike the other and it is larger than the eraser on a pencil.

Melanoma on the bottom of the foot

In this picture, you can see some of the ABCDEs of melanoma, such as more than one color, uneven border, and one half is unlike the other.

Melanoma beneath a toenail

On the feet and hands, melanoma can begin as a dark vertical line underneath a nail.

Melanoma on a callused heel

You may see melanoma that is brown, black, reddish pink, or flesh colored, and it can appear in just about any shape.

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Treatment Of Melanoma Under The Toenail

Melanoma should be removed. The exact treatment will depend on the depth of the melanoma . Usually a margin of healthy tissue is removed to make sure the entire melanoma is removed. If the melanoma is not caught early enough, the toe may need to be amputated.

If notice any changes in your toenails, call 845-298-9074 to set up an appointment at Hollowbrook Foot Specialists. Be sure not to assume you have a fungal toenail and do not treat the problem yourself. Your best bet is to see an board certified expert in Podiatric Medicine and Foot Surgery, such as Dr. David Schlam.

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Symptoms Of Subungual Melanoma

Does the short black line on my toe look like cancer ...
  • Over weeks to months the pigment band may become wider, especially at its base.
  • It usually becomes more irregular in pigmentation and can extend to involve the nail fold, known as Hutchinson Sign.
  • The pigmented lesion may ulcerate or bleed.
  • The nail bed will be painful.
  • A nodule may develop under the nail plate, lifting it up.
  • You may see a thinning, cracking or distortion of the nail plate.
  • In many cases a subungual melanoma is not pigmented.

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Have You Checked Your Nails Lately

Did you know that melanoma and other skin cancers can form under the fingernails and toenails? Melanoma of the nail is not widely known about, and it usually comes as a surprise that people with dark skin are affected by this type of melanoma. In fact, famous musician Bob Marley died in 1981 from an acral lentiginous melanoma, which spread to his lungs and brain from under his toenail.

In recent weeks, Dr Helena was privileged enough to not only attend but also address skin cancer doctors at the Skin Cancer College of Australasia annual congress. The Skin Cancer College Australasia a non-profit, peak body representing more than 1,000 skin cancer practitioners in both Australia and New Zealand. Around 400 doctors were in attendance during the conference.

Dr Helenas topic for this lecture was on how to diagnose melanoma and other cancers that have grown under the nail. Below is a recap of some of the key points, with tips on what to look for.

These cancers are often diagnosed late because they are relatively rare, and the biopsy is challenging. There are different types of nail-related melanoma. Subungual melanoma comes from the nail matrix . Other nail-related cancers include ungula melanoma, which occurs underneath the nail plate, and periungual melanoma, which comes from the skin next to the nail plate.

Presentation Of Melanoma In The Nail Unit

There are 2 main patterns of nail unit melanoma longitudinal melanonychia and amelanotic tumours .3). 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.

Various presentations of nail unit melanoma.

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Could It Just Be A Bruise

Just for some reference, here are some images of bruises of the toe and toenail for you to compare.

The marking on this toenail is a bruise. Note the mark goes across the nail and you can see some bruising on the skin too.

This bruised toenail has a white mark where the damage was caused and the mark looks like blood.

Where there is a marking at the base of the nail like in this image, this is usually caused by impact damage kicking something for example.

Causes And Risk Factors


Anyone can develop ALM. Unlike most other forms of melanoma, ALM does not appear to be related to sun exposure. In some people, it may be due to a genetic risk factor.

Death rates from ALM are higher than those of other forms of melanoma. This may be because ALM can go unnoticed longer, allowing it to spread and become more aggressive before treatment begins. Early diagnosis and prompt treatment have a major impact on whether a person will survive. Its important to note that a large number of people who have ALM are initially misdiagnosed with something else.

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Prognosis And Survival Rate

  • ALM can look a lot like lentigo maligna melanoma but has been noted to be more aggressive and have a worse prognosis.
  • Prognosis is much better the sooner it is diagnosed.
  • Prognosis is directly related to the size and depth of the tumor or lesion.
  • Often times the delay in diagnosis is because clinically it can appear to be benign.

Please note : Famous musician Bob Marley died of this cancer

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Prevention: Know Your Risk

Talk to your doctor about any family history of skin cancer. Other things that raise your risk for sun damage and cancer include:

  • Light skin, hair, or eyes
  • Freckles or moles that are large, numerous, or oddly shaped
  • Lots of time outside, especially at higher altitude or where itâs very hot
  • Illness or medication that weakens your immune system
  • Drugs that make your skin more sensitive to light

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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 .

Is It Toenail Fungus Or Something Else

Skin Cancer of the hand and upper extremity

Odd-looking toenail? It may be a fungal infection, but thereâs a good chance that another condition could be to blame.

If you notice an odd spot on your toenail, you might assume its a fungal infection. However, theres a good chance that its not.

Spots or discolorations on or under a toenail could be bruises resulting from trauma to the nail, blood blisters, warts, or even subungual melanoma, a type of skin cancer, says Ami Sheth, a doctor of podiatric medicine in Los Gatos, California, and a spokesperson for the American Podiatric Medical Association.

Since nail irregularities can be caused by diseases besides these as well, its best to get it looked at, says Dr. Sheth.

Richard Goad, a doctor of podiatric medicine at Baylor Scott & White Health in Waco, Texas, concurs. Sometimes the nail will be the first place to show another underlying problem, Dr. Goad says.

So is it a fungus, a false alarm, or another condition entirely?

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