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 (both in-person and online) during the conference.
Dr Helena’s 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 (where your fingernails and toenails start to grow). 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.
Most cases of subungual melanoma occur in the thumbnail or big toenail. However, a person may experience subungual melanoma on any fingernail or toenail. Part of the danger with this type of melanoma is that it often resembles normal bruising of the nails and may be difficult to identify. Therefore, it is important to note that the core symptoms associated with subungual melanoma are the following:
- brown or black streaks in the nail without any known injury
- streaks on the nails that increase in size
- a bruise on the nail that will not heal or move up as the fingernail grows
- fingernails or toenails that separate from the nail bed
- darkening skin next to the nail
- a nail that bleeds or develops a nodule
- thinning, cracking, or distortion of the nail plate
While subungual melanoma can affect anyone, increased risk factors include:
- being aged over 50
- a history of trauma to the fingers or toes
- darker skin
- an immunosuppressive disorder.
Diagnosis & Treatment
A qualified professional will conduct a physical assessment of the fingernail and ask questions about the lesions on the fingernail. They may ask when the nail streaking began, how the nail has changed over time, and any other relevant medical history. If deemed suspicious, a biopsy is then taken and a pathologist will examine the nail cells to determine if they are cancerous. If classified as melanoma, a doctor will then categorise it based on how many cancerous cells are present and how the melanoma has spread.
The treatment depends on the extent of the melanoma. Once this is determined, a qualified professional will usually start treatment by removing the affected area surgically. Following the surgical removal of the affected area, a doctor may recommend further therapies to prevent the subsequent spread of the cancer.
Does something not look quite right?
We are fortunate to have Dr Helena here in North Queensland, with a wealth of knowledge on the subject. Dr Helena spent time with Professor Luc Thomas, a leading world expert in nail cancers, in Lyon during 2019. Since then, Dr Helena has had many referrals for nail problems and as a result has been able to create teaching videos on how to perform nail cancer biopsy for skin cancer colleagues.
A person waits an estimated 2.2 years from the onset of their symptoms until diagnosis of subungual melanoma. However, it is so important to seek proper diagnosis, as soon as symptoms become noticeable. Checking your nails and showing any changes to a trained professional can help reduce your chances of an undetected subungual melanoma.