December 22, 2017 | Stephen Fine, Founder and President
Toenail and Fingernail Melanoma
Toenail and Fingernail Melanoma, (more commonly known as Subungual Melanoma) is a rare type of the disease that falls within the Acral Lentiginous Melanoma classification. Like Ocular Melanoma, subungual is one of the few melanomas that medical science does not believe to be caused by UV (ultraviolet) ray exposure.
Where on the Body is Subungual Melanoma Located?
While SM can develop underneath any of our 20 nails, it is most commonly found under a big toenail. On our hands, it’s more likely to be found under a thumbnail.
Who Gets Subungual Melanoma?
Anyone of either gender or any color can be stricken by SM, with the same prevalence throughout all races. However, it’s the most often diagnosed melanoma among people with dark skin tones. Indeed, it was SM that claimed the life of legendary reggae singer Bob Marley at the age of 36.
What to Look for When Checking for Subungual Melanoma
SM’s appearance per the cited, source article:
“Subungual melanoma often starts as a pigment band visible the length of the nail plate (melanonychia). Over weeks to months, the pigment band:
- Becomes wider, especially at its proximal end (the end of the nail that is closest to the cuticle)
- Becomes more irregular in pigmentation including light brown, dark brown
- Extends to involve the adjacent nail fold (Hutchinson sign)
- May develop a nodule, ulcerate or bleed
- May cause thinning, cracking or distortion of the nail plate (nail dystrophy).”
These 3 photos are examples of authentic subungual melanomas:
Why are the Above Photographs referenced as “Authentic” Subungual Melanomas?
SM’s have the unfortunate characteristic of being very similar in appearance to Black Thumbnail Fungus and Subungual Hematomas. The former is a very common nail infection, and the latter is just an ordinary nail bruise. Both can be annoying and/or painful, but they are easily treatable. Whereas SM can easily be fatal if ignored after being mistaken for either.
Subungual Hematomas
These bruises have been incurred by countless people at one time or another. They’re obtained through accidental actions such as slamming a thumb in a door, or hitting it with a hammer. Pressure generated by the collection of blood under the nail often causes intense pain. Melanomas under the nail are usually painless unless they are late stage.
This presents another problem as many assume that if something doesn’t hurt, there’s nothing to be concerned about.
This photo is one example of a subungual hematoma:
Most nail fungus infections are yellowish, but can sometimes be black. This photo is one example of black thumbnail fungus:
As can now clearly be seen, if all these photos were presented without captions, it would be very difficult to distinguish the 2 benign conditions from the 3 potentially lethal ones above them.
It bears repeating. The single most important factor in either being cured of melanoma or dying from it, is the speed of diagnosis and treatment. With suspicious changes to the skin, nothing should ever be brushed off or assumed.
*Additional source article information & photographs: DermNetnz.org, (Licensing)