Subungual melanoma, also referred to as cancer of the nail unit, is a type of malignancy that arises in the tissues of the nail bed. Melanoma is a type of cancer that develops in cells called melanocytes. Melanocytes are cells that produce melanin, the pigment that gives skin, hair, and eyes their color.
They're often misdiagnosed as a fungal infection due to their characteristic changes in color and nail texture.5 Things Your Nails Can Say About Your Health
Subungual melanoma is a relatively uncommon condition—affecting 0. It's also more common in older people, in a woman's 60s and a man's 70s. Subungual melanomas usually appear as a darkened streaks that run longitudinally perpendicular to the cuticle.
Roughly half of these streaks are brown, blue, or black, while the other half are non-pigmented. As time progresses, the portion closest to the cuticle may become wider. This refers to the appearance of a streak extending from to the top of the nail all the way to the nail bed and into the cuticle itself. This helps differentiate it from other nail-related conditions in terms of its uniformity, longitudinal discoloration, and involvement of the cuticle.
As the melanoma continues to grow, it can cause bleeding, the formation of a nodule, or deformity to the nail itself. Ultraviolet UV radiation neither contributes to nor speeds the development of a subungual malignancy.
Dermatologists will use a tool called a dermascope, which provides a magnified view of the nail and surrounding tissue. Ultimately, a visual examination has its limitations, especially since subungual melanoma is so infrequently seen.
Causes and Risk Factors of Longitudinal Melanonychia
A definitive diagnosis can only be made with a biopsy. Typically, an excisional biopsy is performed to remove the entire lesion plus some of the surrounding tissue. A less-invasive punch biopsy may be used if the signs are uncertain. Depending on the size and depth of a subungual melanoma, further testing will be needed to determine the stage of the disease. To determine whether the melanoma has metastasized, there are various tests the oncologist can perform, including the biopsy of sentinel lymph nodes the nodes nearest the tumor and imaging techniques such as computerized tomography CT scan or positron emission tomography PET scan.
The treatment of subungual melanomas has changed considerably in recent years. In the past, amputation of the entire toe or finger was considered the treatment of choice. Today, many subungual melanomas are treated more conservatively with only the local removal of the tumor. For toenails, amputation to the second joint is more common. A review of the medical literature suggested that a more conservative approach may work just as well as a complete amputation.
Moreover, complete amputation was not shown to improve survival times in people with a subungual melanoma. Response to treatment can vary based largely on the stage of cancer.
Outcomes for people with subungual melanoma tend to be poorer than other types of melanoma, often due to delay in seeking diagnosis and treatment. This only highlights the need for action should you find any changes to the nail or skin that seem abnormal or fail to get better. Early intervention is the surest way to achieve treatment success. If you've been diagnosed with subungual melanoma, it's important to find a specialist experienced with the disease.
Learn as much as you can about your cancer. Ask for and accept help. Become involved with online support communities that can share their experiences and insights.
Limiting processed foods and red meats can help ward off cancer risk. These recipes focus on antioxidant-rich foods to better protect you and your loved ones.Have you ever looked at your toenail and notice a dark line on the nail? Well, that mark can be harmless or it can be cancer.
Get it checked out. Melanonychia occurs because of increased production of melanin by melanocytes in the nail matrix growing cells. Melanonychia most commonly occurs in people with darker skin color. The condition is less common in other races and affects males and females equally and increases with age. One or more of the toes may be involved but the big toe is the most common site for the melanonychia.
Approximately two thirds of cases have a brown-black color, and one third of cases have a lighter color. The width of the band can vary from 1 millimeter to several millimeters. The bands are wider than 3 millimeters in greater than 50 percent of people.
The wider and darker the bands are, the more concerning they are. There are many causes of melanonychia including medications — inflammatory disorders, trauma, fungal infections and systemic diseases. The most concerning cause of melanonychia is melanoma cancer of the nail.
Thankfully only a small number of people with longitudinal melanonychia will have subungual nail melanoma. Person with melanonychia will usually come to the doctor with a history of a tan, brown or black lengthwise streak or line on the nail that extends from the back of the nail or cuticle area to the free end of the nail. There is usually no pain, itching, or burning.
These streaks may be common and often people will say they had the dark bands on the nail for a long time. It is still recommended that they see a podiatrist to have it checked out anyway. When you see the podiatrist, a careful history will be taken and will include information on the medications taken, past treatments, hobbies, illnesses, family history, any history of trauma to the area, prior history of a biopsy of the nail, number of nails affected, results of any prior nail clippings sent for examination under a microscope, results of cultures sent for infectious organisms, change of appearance of the band over time.
After seeing the podiatrist, they will most likely biopsy the nail to determine whether or not the melanonychia is benign not cancerous or malignant cancerous. On the other hand with toenail melanoma, there is a long-standing history of melanonychia that recently changed in appearance.
Changes that are cause for concern include changes in the color, pattern, or size of the band, new onset of pain or ulceration in the site of the melanonychia, or the presence of blood under the nail. Other signs of melanoma may be melanonychia developing abruptly in a previously normal nail plate and pigment streak getting suddenly darker or wider.
For the majority of the cases of melanonychia there is no treatment needed. When treatment is needed, it is based on the cause of the condition.
If melanonychia is secondary to a drug, discontinuation of the offending agent may result in clearance. If there is any concern about the melanonychia being melanoma cancerous the podiatrist will perform a nail biopsy so it can be looked at under a microscope. Similar to a mole on the skin, the nail and the band should be checked regularly for changes that may indicate they are no longer harmless.
For more information, visit www. Monday, Apr 13, Obituaries About Us. March 4, The Nassau Guardian. Symptoms Person with melanonychia will usually come to the doctor with a history of a tan, brown or black lengthwise streak or line on the nail that extends from the back of the nail or cuticle area to the free end of the nail. Treatment For the majority of the cases of melanonychia there is no treatment needed.By proceeding, I accept the Terms and Conditions.
I empathize with you because you are facing a problem that has not been explained and dealt with to your complete satisfaction till date I will help you to have essential knowledge as well guide you to go for necessary investigations and management. I have examined your pics as well and think that keeping all the facts stated by you in mind, there is less probability of your problem being malignant and thereby needing any major surgery.
However, it is our duty to do all that is possible to keep you safe and healthy. In order to rule out any risk of spread of the problem, I would advise anyone having similar profile to undergo nail matrix biopsy. It is possible to comment upon the lesion sometimes just on the basis of Dermoscopy. I would be glad to see the reports of Dermoscopy if that is available with you.
Here I would point out that racial, hormonal, traumatic, and association with other skin diseases can too sometimes present in this manner and hope that these have been looked into by the dermatologists that you visited earlier. I would like to know if any other nails too are involved or oral lining or genital linings are similarly affected. Please also inform of any family history of such diseases in the family. Sun exposure and food habits are unlikely to have caused this. The details of outcome, amputation, morbidity, and such queries should be deferred for now as these depend upon the outcome of biopsy report.
Even in the worst cases, a complete excision of lesions should result in cure. I feel that maintaining a positive attitude will help resolve the issue more effectively.
We are going to work together towards your complete recovery. In the meantime, no special measures are needed except for close observation an a photographic record of the progress. I assume that no staining agents, chemicals, drugs, or hormonal preparations have been used and as such are not correlated to the existing problem. I am sure, you will supply the required details and together we can handle the problem in the best possible way.
Our best wishes! Coronavirus Doctor Consultation Are you a Doctor? Login Register. Your Name :. Your e-mail :. Password :. Confirm Password :. Remember me. Register Already registered? Continue Already registered? By proceeding further you accept the Terms and Conditions.Melanonychia refers to a condition involving your toenails or the nails of your fingers. In this condition, black or brown lines tend to appear on your nails. This decolorization usually appears in the form of a stripe that begins at the bottom of the nail bed and comes all the way up to the top.
Melanonychia can occur in one or multiple nails. Sometimes, these lines naturally occur on your nails, especially if you have a dark complexion.
What are the causes of melanonychia?
There can be multiple reasons why you are suffering from this condition. Therefore, it is important that you get an appointment fixed with a doctor.
This is also important because sometimes, melanonychia might be associated with a dangerous health issue. Keep reading to know about melanonychia, also known as longitudinal melanonychia or melanonychia striata.
The nails of your fingers and toes are translucent and do not contain any pigments. Melanonychia, on the other hand, occurs as soon as the pigment cells, also called as the melanocytes, start depositing melanin pigment into your nails. Melanin is a type of pigment with brown color which gets deposited into your nails and starts accumulating. As the nail grows, it causes black or brown stripes to appear on your nails.
What causes melanocytes to start depositing melanin in your nails? There are two processes, each with a different set of causes. Sometimes, genetics may also play a role. For example, people with an African descent are more likely to experience melanonychia as compared to other races. The treatment for melanonychia varies from person to person and mainly depends upon the underlying cause. If your condition is occurring due to a benign cause which is noncancerous, there may be no need of undertaking any treatment.
If the condition is being caused by a certain medication, the doctor may ask you to stop taking it or change it altogether if possible. If you are unable to stop taking the specific medication, you may have to live with melanonychia for the rest of your life as a side effect to the drugs you are taking. If the melanonychia is cancerous or malignant, you may just have to get the affected area completely removed. This may mean that you will have to let go the whole of your nail or a small part of it.DermNet provides Google Translate, a free machine translation service.
Note that this may not provide an exact translation in all languages. Melanonychia is brown or black discolouration of a nail. It may be diffuse or take the form of a longitudinal band. Benign longitudinal melanonychia. Melanonychia can present in individuals of all ages, including children, and affects both sexes equally. It is more prevalent in people with skin of colour, especially Fitzpatrick skin type V and VI. Melanonychia can also be associated with genetic disorders, injury, medications, nutritional deficiency, endocrine disease, connective tissue diseaseinflammatory skin disease, a local tumouror nail infection.
The nail plate is a hard, translucent structure made of keratin.
Nail Pigment Changes Can Mean Cancer
It is not normally pigmented. Melanocytes typically lie dormant in the proximal nail matrix where the nail originates. Melanin is deposited into the growing nail when melanocytes are activated, resulting in a pigmented band — this is longitudinal melanonychia. The deposition of melanin in the nail plate can result from 2 processes:. Melanocytic hyperplasia refers to an increased number of melanocytes within the nail matrix.
This can represent a benign or malignant process. Melanocytic naevi arise more commonly in children. Histologically there are nests of naevus cells. Lentigines are seen more commonly in adults. Nests are absent. Melanoma of the nail unit most commonly affects the thumbs, index fingers and big toes. Melanocytic activation is an increase in the production and deposition of melanin into the nail cells onychocyteswithout an increase in the number of melanocytes. The causes of melanocytic activation are listed in the table below.
Intraepidermal carcinoma. Basal cell carcinoma. Cushing syndrome. Human immunodeficiency virus infection HIV. Systemic sclerosis. X-ray exposure; electron beam therapy.This is a preview of subscription content, log in to check access. Diagnosis and management of nail pigmentations.
J Am Acad Dermatol ; — Dermoscopy of the nail bed and matrix to assess melanonychia striata. J Am Acad Dermatol ; —6. Dermoscopic features in fungal melanonychia. Clin Exp Dermatol ; —8. A clinical, histopathologic, and outcome study of melanonychia striata in childhood. J Am Acad Dermatol ; —9. When all you have is a dermatoscope-start looking at the nails. Dermatol Pract Concept ; 4: 1— Baran R, Simon C.
Feily A. Images in clinical medicine. Squamous-cell carcinoma of the nail bed. N Engl J Med ; Pigmented squamous cell carcinoma of the nail bed presenting as a melanonychia striata: diagnosis by perioperative reflectance confocal microscopy.
Br J Dermatol ; —9. Subungual pigmented squamous cell carcinoma presenting as longitudinal melanonychia: a case report with review of the literature.
Int J Clin Exp Pathol ; 7: —7. Intraoperative diagnosis of nonpigmented nail tumours with ex vivo fluorescence confocal microscopy: 10 cases. Br J Dermatol ; — Download references. Correspondence to Takeshi Namiki. Nojima, K. Pigmented squamous cell carcinoma of the right thumb: longitudinal melanonychia and dermoscopic features.He is also chief of the nail section and clinical associate professor of dermatology at New York University Medical Center. Kechijian has written numerous articles and given many presentations on nail diseases and disorders.
He is currently writing a chapter on nails for a medical textbook. Because nail technicians see more nails than anyone, they are in an ideal position to detect nail disorders early and refer clients to a dermatologist when necessary. One nail disorder that always should be referred to a dermatologist is longitudinal melanonychiabecause it can be an indicator of melanoma, a potentially deadly form of cancer that can be cured if diagnosed and treated early.
Longitudinal melanonychia is a pigmented band that runs fro the proximal nail fold to the nail tip. The band, which can be tan, brown, or black, is caused by an increase in melanin pigment in the nail plate. Melanin is the same pigment that determines skin color and allows people to tan. Although longitudinal melanonychia is not common in people with fair complexions, it is very common in dark-skinned individuals of various ethnic origins, especially people of African, Chinese, Japanese, Indian and Latin descent.
Generally, the darker the skin, the more likely a person is to develop longitudinal melanonychia as she ages. In fact, by age 70, almost all black individuals have longitudinal melanonychia. Not all pigmentary changes of the nails are longitudinal melanonychia.
The most common discoloration confused with longitudinal melanonychia is blood collected under the nail plate, called a subungual hematomawhich makes the nail appear black or brown. Subungual hematomas are caused by trauma and are common on the hands and feet. Being able to make the distinction between pigmentary changes caused by blood and those caused by melanin is obviously important.
When brown pigment suddenly appears under the nail following an injury, you can safely assume the disorder is a subungual hematoma, which will grow out with the nail plate, while longitudinal melanonychia will not. If you are uncertain about which is causing a pigmentation change, refer the client to a dermatologist. Other conditions can simulate longitudinal melanonychia, but are less dangerous.
For example some oral medications can cause the nail plate to discolor. Bacteria, yeast, and fungal infections of the nail also cause color changes. Although a biopsy of the nail is often necessary to establish the cause of longitudinal melanonychia, careful examination of the nail by a dermatologist can provide important clues to whether longitudinal melanonychia is caused by a benign disorder or melanoma.
The presence of more than one pigmented band, for example, is a clue that longitudinal melanonychia is benign non-cancerous in origin.