Subungual melanoma – everything you need to know about it

The darker spot under the nail is not always the result of an impact or bacterial infection. It may be one of the symptoms of melanoma. And although most of us associate this cancer with moles or spots on the skin, experts warn – similar thinking leads to the fact that in Poland this type of melanoma is diagnosed only three years after the first symptoms. It is often too late then.

What is subungual melanoma?

Bob Marley suffered from subungual melanoma. In the musician’s case, it was located under the nail of the toe. The artist died because he had metastases to other organs. Recently, the case of Karolina Jasko, an American model of Polish origin, was famous. She was diagnosed with melanoma after noticing a dark strip under her fingernail while visiting a manicure salon. Jasko at first thought it was a bruise, but decided to check it with a doctor. The diagnosis was clear – subungual melanoma. An operation was necessary during which the nail plate was removed.

It is an insidious disease which, apart from the characteristic dark stripe under the fingernail, gives practically no symptoms. It develops unnoticed and leads to metastasis elsewhere in the body. It is usually diagnosed at this stage, but in many cases it is too late for treatment.

Symptoms of subungual melanoma

It starts innocently. A darker discoloration appears under the nail plate, which most patients ignore, associating it with mechanical trauma, infection or discoloration after using nail polish.

Initially, the melanoma takes the form of a dark streak that runs perpendicular to the cuticle under the nail plate. In half of the patients, the streak becomes black, brown or dark blue. Unfortunately, in the rest of the patients, the streak is not pigmented and becomes visible only at a later stage of the disease.

1. Find out more: Facts and myths about melanoma

Over time, brown or brown spots form under the plate, and the nail itself deforms, cracks and deforms. Dark lumps appear under and around the nail, and they may also bleed. However, it should be remembered that not every neoplastic lesion under the nail will acquire a dark pigment. It often happens that melanoma develops only by changing the shape of the nail. The symptom that most often allows for proper diagnosis is the so-called the symptom of micro-Hutchinson. It is a darker color of the skin around the affected nail.

The causes of subungual melanoma

Experts agree – the vast majority of melanomas arise from too much sun exposure. However, the development of subungual melanoma is not caused by the sun’s rays. In most cases, doctors indicate mechanical injuries or previous infections. The history of cancer in the family, old age and the patient’s darker complexion are also important.

This type of melanoma is relatively rare. It is estimated that it develops in 3,5 percent. patients with cutaneous melanoma. It is also worth knowing that lesions most often appear under the nail of the thumb or big toe. They always cover only one nail plate.

Diagnosis and treatment of subungual melanoma

Subungual melanoma is difficult to detect on its own. Therefore, if something changes in the appearance of your nail and it starts to bother you, it is worth consulting a dermatologist. The specialist will carefully examine the nail and any changes. Usually, dermatoscopy is used for this purpose, i.e. a method that allows you to examine changes on the skin with repeated approaches thanks to special equipment.

This examination is completely painless, and during its performance, the doctor diagnoses the lesion, guided by the CUBED rule:

1. C (colouredlesionwhereanypartisnot skincolour) – a birthmark other than the color of the skin;
2. U (Uncertaindiagnosis) – uncertain diagnosis;
3. B (Bleedinglesionson thefootorunderthenail) – a bleeding, oozing birthmark;
4. E (Enlargementordeteriorationof alesionorulcerdespitetherapy) – enlargement or ulceration of the nevus despite treatment;
5. D (delayinhealingofanylesionbeyond2months) – delay in healing over two months.

If anything disturbs the specialist during the examination or when the above rules are covered by the lesion, he will decide to excise it or take a sample for histopathological examination.

If the diagnosis of subungual melanoma is confirmed, the affected phalanx is usually amputated. The stage of the disease determines subsequent treatment. It must be remembered that the later the diagnosis, the more radical the treatment will be. Refusal to amputate, as in the case of Bob Marley, usually ends tragically, especially since, according to doctors, it usually takes 3 years from diagnosis to treatment. During this time, the cancer often begins to wreak havoc in other parts of the body.

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