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Black spots under the toenail can be concerning and shouldnt be ignored. Are you worried about a black spot under your toenail? We can help. To learn more, contact U.S. Dermatology Partners today to make an appointment with one of our board-certified dermatologists. We have multiple locations throughout the country, so fill out our simple online form to get in touch with us. One of our local team members will reach out to you shortly to answer your questions or schedule an appointment for you to visit us soon.
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Concerned About What Youre Seeing
Nail problems should never have you worried or keep you awake at night and if they are, we highly recommend trusting those instincts and having your nails checked. Our podiatry team will give you an idea of what the likely cause for your nail discolouration is and treat it accordingly or refer you to a specialist if we suspect something more sinister or further investigation is required.
Nail Discoloration And Other Signs Of Subungual Melanoma
Subungual Melanoma is most easily defined as a cancer of the nail unit. Identified as one of the three main types of nail cutaneous cancer, subungal melanomas is the only one that originates from the tissue beneath the nail base, known as the nail matrix. Within the medical community, it is also referred to as Malignant Subungual Melanoma, Melanoma of Nail Matrix or Nail Matrix Melanoma.
Like most cancers, early detection is optimal. But, in the cases of subungal melanoma, it is often misdiagnosed as merely a fungal infection. The only way to confirm this type of cancer diagnosis is by a biopsy. At which point the stage, treatment plan, and prognosis are assessed.
Symptoms of Subungual Melanoma
There are some visual clues unique to Subungual Melanoma. Unfortunately, late detection is problematic as it can be masked by other factors such as injury, hematomas, or fungal infection, but outlined below are some observational highlights to be concerned with. Of note: The areas most affected are the thumbnail or the big toenail.
- Subungual melanomas of the nail unit usually appear as darkened streaks that run longitudinally . Roughly half of these streaks are brown, blue, or black, while the other half are non-pigmented.
Causes and Risk Factors of Subungal Melanoma
Currently, the exact cause of development of Melanoma of Nail Unit is unknown. However, the potential causes may include:
Subungual Melanoma Presentation Signs On the Toenail
Prevention
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Is This Black Spot Under My Toenail Cancer
Dermatologists often see patients concerned about a black spot under their nail. While it could be an indication of skin cancer, there are many other conditions that present this symptom. If youre concerned about a black spot under your toenail, keep these details in mind and schedule an appointment with your provider right away.
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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If You See Dark Streaks On Your Nails It Could Be A Melanoma
A dark streak on your nail, known as melanonychia, could be a warning sign of melanoma, Skylar Souyoul, MD, a board-certified dermatologist, recently told the AAD. The dark streaks are usually vertical and tend to look like a “brown or black band in the nail,” Souyoul says, though they can range from light to dark.
They are most likely to appear on the thumb or big toe of a person’s dominant hand or foot, but can appear on any nail. According to the National Center for Biotechnology Information, your thumb and big toe account for 75 percent to 90 percent of nail bed cancers, which are known as subungual melanoma. And this streak is often one of the first signs. “Early subungual melanoma often presents as longitudinal melanonychia,” wrote the authors of a 2016 study on the subject, published in the journal Australian Family Physician.
“While subungual melanoma is a relatively rare condition compared to other skin cancers, it can lead to serious complications,” the experts at Healthline say. “Early detection and treatment is a must. It’s important to learn the signs of subungual melanoma so you can get help before the cancer spreads.”
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What Alm Looks Like
ALM is typically a dark spot of skin that is surrounded by skin that remains your normal skin color. There is often a clear border between the dark skin and the lighter skin around it. This contrast in color is one of the most noticeable characteristics of this type of melanoma. ALM may be hard to recognize at first if the patch of darkened skin is small and looks like little more than a stain or bruise.
Note that ALM may not always be dark-colored or even dark at all. Some spots may be reddish or orange in color these are called amelanotic melanoma. Read more about amelanotic melanoma.
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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
What Does Nail Melanoma Look Like
Karolina Jasko has a family history of melanoma, so shes no stranger to paying attention to her skin.
Her mother, who battled the deadliest form of skin cancer twice and recovered, has always been vigilant about checking Jaskos moles for any changes.
See more in the video above
But melanoma was still able to sneak up on Jasko in a spot neither she nor her mother suspected: one of Jaskos nails.
Dr Vishal Patel is assistant professor of dermatology at the George Washington University School of Medicine & Health Sciences in Washington, DC.
Experts like him worry such cases may be on the rise with the popularity of gel manicures that require the polish to be hardened under ultraviolet light.
Its like tanning beds for your hands, said Patel, who is also director of the cutaneous oncology program at the GW Cancer Center.
He was not involved in Jaskos case but commented in general.
Were seeing a lot of patients having not only melanomas, but all types of skin cancers around the fingertips and the cuticles.
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The Abnormal Nail Plate Associated With Pigment
A nail plate that is structurally altered presents a different scenario. Where there is a longitudinal melanonychia associated with loss of nail integrity this raises concern and needs immediate assessment. In other instances, the pigment may be broken up or scattered within a creamy yellow nail plate. Where there is no preceding history of longitudinal melanonychia, this may represent a pigmented onychomycosis with damage to the nail plate. This can be difficult to assess. Unlike melanocytic pigment which starts in the matrix, the pattern of onychomycosis usually extends from the distal free edge with proximal progression. Early reassurance can be given if the pigmented change and dystrophic nail can all be trimmed away with no disturbance of surrounding skin and there is no sign of a more proximal origin to the pathology. Suspicion of fungus should always be explored by mycological assessment and in particular culture. There is a wide variety of potential organisms . Some of the pigmented fungi are non-dermatophytes and may represent a therapeutic challenge likely to be surmounted only if the pathogen is known.
Table 6 The ABCDE of nail melanoma after Levit
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
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How Is Melanoma Of Nail Unit Diagnosed
A thorough history and a complete physical exam by a physician are crucial for the diagnosis of Melanoma of Nail Unit. This is followed by some tests which include:
- Dermoscopy: Dermoscopy is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
- Tissue biopsy: A sample from the affected nail region is taken and examined under a microscope for signs of cancer by a pathologist. The types of biopsy performed include:
- Excisional biopsy: After numbing the area with a local anesthetic, the entire mole is removed with a small border of surrounding skin. Where possible, this is the generally preferred method
- Punch biopsy: After numbing the area with a local anesthetic, a circular blade is pressed into the skin around the suspicious area, and a round piece of skin removed. This type of biopsy is carried out, when the lesion is large in size
- Incisional biopsy: After numbing the area with a local anesthetic, a portion of the tumor is removed using a surgical knife
- Sentinel lymph node biopsy: Performed to determine if the melanoma has spread to nearby lymph nodes. A dye is injected into the area from where the melanoma is removed. The first lymph node that takes up the dye is biopsied and examined for cancer cells, under a microscope
What Are The Signs And Symptoms Of Melanoma
Melanoma is a skin cancer that can show up on the skin in many ways. It can look like a:
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Changing mole
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Spot that looks like a new mole, freckle, or age spot, but it looks different from the others on your skin
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Spot that has a jagged border, more than one color, and is growing
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Dome-shaped growth that feels firm and may look like a sore, which may bleed
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Dark-brown or black vertical line beneath a fingernail or toenail
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Band of darker skin around a fingernail or toenail
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Slowly growing patch of thick skin that looks like a scar
Early melanoma
This early melanoma could be mistaken for a mole, so its important to look carefully at the spots on your skin.
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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.
Toenail Melanoma Symptoms Causes And Treatments
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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What Are The Signs And Symptoms Of Melanoma Of Nail Unit
A melanoma can develop from an existing mole or appear as a new spot. The signs and symptoms may include:
- A pigmented area that is Asymmetrical in shape, whose Borders are irregular or ragged
- A pigmented area that is not Colored uniformly, unlike a benign mole, which has an even distribution of shades
- Any suspicious looking spot, whose Diameter is more than ¼ inches . Although, in Melanoma of Nail Unit, it can be less than 6 mm
- Any suspicious looking spot that is Evolving, or changing in shape/color
These signs are often collectively referred to as the âABCDE characteristicsâ of melanoma, by physicians.
- A suspicious looking spot or a âpotential melanomaâ often differs in appearance from other benign moles on the body. This variability is sometimes called the ugly duckling sign by physicians
- A suspicious pigmented area/spot showing a spread of color to the surrounding skin and with any swelling, redness or itching . Such areas may also be scaly, or exhibit some oozing of fluid, or bleeding
The following signs and symptoms of Melanoma of Nail Unit may be observed:
What Are The Possible Complications Of Melanoma Of Nail Unit
Early stage melanomas include melanoma in situ or locally invasive melanomas that have spread to the deeper layers of the skin. Advanced stage Melanoma of Nail Unit can invade into the tissue and bone beneath the nail. It can also metastasize beyond the nail and skin, to the lymph nodes and other organs.
Organs that are commonly involved in metastasis include:
- Lung
- Gastrointestinal tract
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What Does Nail Melanoma Look Like Skin Cancer Can Hide As Line On Nail
Karolina Jasko has a family history of melanoma, so she’s no stranger to paying attention to her skin. Her mother who battled the deadliest form of skin cancer twice and recovered has always been vigilant about checking Jaskos moles for any changes.
But melanoma was still able to sneak up on Jasko in a spot neither she nor her mom suspected: one of Jaskos nails.
Experts like Dr. Vishal Patel, assistant professor of dermatology at the George Washington University School of Medicine & Health Sciences in Washington, D.C., worry such cases may be on the rise with the popularity of gel manicures that require the polish to be hardened under ultraviolet light.
Its like tanning beds for your hands, Patel, who is also the director of the cutaneous oncology program at the GW Cancer Center, told TODAY. He was not involved in Jaskos case, but commented in general.
Were seeing a lot of patients having not only melanomas, but all types of skin cancers around the finger tips and the cuticles.
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.
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