Table of ContentsView AllTable of ContentsSymptomsCausesDiagnosisTreatment
Table of ContentsView All
View All
Table of Contents
Symptoms
Causes
Diagnosis
Treatment
Subungual melanoma, sometimes called nail apparatus melanoma, is a type of malignancy that arises in the tissues of the nail bed.Melanomacancers develop in cells called melanocytes. Melanocytes are cells that produce melanin, the pigment that gives skin, hair, and eyes their color.
Subungual melanomas can occur on any of the fingernails or toenails. These nail cancers are often misdiagnosed as a fungal infection due to their characteristic changes in color and nail texture.
Melanoma of the nail is a relatively uncommon condition, affecting 0.7% to 3.5% of people with malignant melanomas worldwide.It tends to occur more in darker-skinned individuals, including African-American, Asian, and Hispanic populations.
It’s also more common as you age, with one study finding people were diagnosed at an average age of 69 years and 60% of them were male.
Subungual melanomas usually appear asdarkened 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 cancer progresses, more streaks may appear, often with different colors. As time progresses, the portion closest to the cuticle may become wider.
This helps differentiate it from other nail-related conditions in terms of its uniformity, longitudinal discoloration, and involvement of the cuticle.
Hutchinson’s sign is a common finding in most subungual melanomas.This refers to the appearance of a streak extending from the top of the nail all the way to the nail bed and into the cuticle itself.
As themelanoma continues to grow, it can cause bleeding, the formation of a nodule, or deformity to the nail itself.
Verywell / Nusha Ashjaee
The reasons for why subungual melanomas develop remain unknown, but there are risk factors associated with its development. These include:
One thing that doesn’t appear to be a factor in subungual malignancy is sun exposure.Ultraviolet (UV) radiationneither contributes to nor speeds its development, which differentiates it from all other types of melanoma.
A diagnosis of subungual melanoma will usually be made with careful inspection of the nail and lesion.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. As a result, it’s often mistaken for more common conditions, such as:
A definitive diagnosis can only be made with abiopsy. Typically, an excisional biopsy is performed to remove the entire lesion plus some of the surrounding tissue.A less-invasivepunch biopsymay be used if the signs are uncertain.
Checking Yourself for Nail CancerThe American Academy of Dermatology suggests checking your nails for cancer as well as your skin. This may lead to earlier diagnosis and treatment. You should watch for:Melanoma nail streaks, like brown or black bands, often on your thumb or big toeSkin that’s darker near the nailA nail that lifts away from the finger or toeNails that split down the middleBumps or nodules under the nail
Checking Yourself for Nail Cancer
The American Academy of Dermatology suggests checking your nails for cancer as well as your skin. This may lead to earlier diagnosis and treatment. You should watch for:Melanoma nail streaks, like brown or black bands, often on your thumb or big toeSkin that’s darker near the nailA nail that lifts away from the finger or toeNails that split down the middleBumps or nodules under the nail
The American Academy of Dermatology suggests checking your nails for cancer as well as your skin. This may lead to earlier diagnosis and treatment. You should watch for:
Staging of Melanoma
Depending on the size and depth of a subungual melanoma, further testing will be needed to determine the stage of the disease. As with other forms of cancer, the stage can vary fromcarcinoma in situ(pre-cancer) all the way to stage 4 metastatic disease (where cancer has spread to other organs).
To determine whether the melanoma has metastasized, there are various tests the oncologist can perform. They include:
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. When amputation is indicated, it often involves only the first joint nearest the fingernail. For toenails, amputation to the second joint is more common.
A2014 reviewof 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.
For advanced subungual melanoma, other types of therapy may be needed, including:
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.
One study of 118 people with nail cancer who had sentinel lymph node biopsies found that:
The overall 5-year survival rate in this group was 69.5%, but the outlook is much lower for people diagnosed with stage 4 subungual melanoma, at just 15–20%.
The subungual melanoma survival rates highlight 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.
A Word From Verywell
If you’ve been diagnosed with subungual melanoma, it’s important to find a specialist experienced with the disease. Subungual melanomas are fairly uncommon, and the lack of experience can result in an unnecessarily aggressive approach to treatment.
While having an excellent care team around you is important,youremain the most important facet of that team. 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.
Common and Uncommon Nail Symptoms
12 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Chakera AH, Quinn MJ, Lo S, et al.Subungual melanoma of the hand.Ann Surg Oncol. 2019;26(4):1035-1043. doi:10.1245/s10434-018-07094-wVasudevan B, Rana V, Mitra D, Neema S, Verma R, Kakkar S.A rare case of subungual melanoma.Indian J Dermatol. 2015;60(2):188. doi:10.4103/0019-5154.152526Gupta AK, Bharadwaj M, Mehrotra R.Skin cancer concerns in people of color: risk factors and prevention.Asian Pac J Cancer Prev. 2016;17(12):5257-5264. doi:10.22034/APJCP.2016.17.12.5257LaRocca CJ, Lai L, Nelson RA, Modi B, Crawford B.Subungual melanoma: a single institution experience.Medical Sciences. 2021;9(3):57. doi:10.3390/medsci9030057Cochran AM, Buchanan PJ, Bueno RA, Neumeister MW.Subungual melanoma: a review of current treatment.Plast Reconst Surg2014;134(2):259-273. doi:10.1097/PRS.0000000000000529Sohng C, Han MH, Park D, Park KD, Jang YH, Lee WJ,et al.Clinical features of subungual melanoma according to the extent of Hutchinson’s nail sign: a retrospective single-centre study.J Eur Acad Dermatol Venereol. 2021 Feb;35(2):380-386. doi:10.1111/jdv.16762Reilly DJ, Aksakal G, Gilmour RF, et al.Subungual melanoma: Management in the modern era.J Plas Reconstr Aesthet Surg. 2017;70(12):1746-1752. doi:10.1016/j.bjps.2017.08.001American Academy of Dermatology.How to check your nails for melanoma.Wollina U, Nenoff P, Haroske G, Haenssle HA.The diagnosis and treatment of nail disorders.Dtsch Arztebl Int. 2016;113(29-30):509-18. doi:10.3238/arztebl.2016.0509Starace M, Alessandrini A, Brandi N, Piraccini BM.Use of nail dermoscopy in the management of melonychia: review.Dermatol Pract Concept.2019;9(1):38-43. doi:10.5826/dpc.0901a10Holman BN, Van Gulick RJ, Amato CM, MacBeth ML, Davies KD, Aisner DL,et al.Clinical and molecular features of subungual melanomas are site-specific and distinct from acral melanomas.Melanoma Res. 2020;30(6):562-573. doi:10.1097/CMR.0000000000000688Liu WF, Yang FJ, Niu XH, Sun Y, Huang Z, Jin T,et al.Predictive value of sentinel lymph node biopsy in prognosis of acral melanoma.Chinese Journal of Oncology. 2021;43(1):147-154. doi:10.3760/cma.j.cn112152-20200702-00620
12 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Chakera AH, Quinn MJ, Lo S, et al.Subungual melanoma of the hand.Ann Surg Oncol. 2019;26(4):1035-1043. doi:10.1245/s10434-018-07094-wVasudevan B, Rana V, Mitra D, Neema S, Verma R, Kakkar S.A rare case of subungual melanoma.Indian J Dermatol. 2015;60(2):188. doi:10.4103/0019-5154.152526Gupta AK, Bharadwaj M, Mehrotra R.Skin cancer concerns in people of color: risk factors and prevention.Asian Pac J Cancer Prev. 2016;17(12):5257-5264. doi:10.22034/APJCP.2016.17.12.5257LaRocca CJ, Lai L, Nelson RA, Modi B, Crawford B.Subungual melanoma: a single institution experience.Medical Sciences. 2021;9(3):57. doi:10.3390/medsci9030057Cochran AM, Buchanan PJ, Bueno RA, Neumeister MW.Subungual melanoma: a review of current treatment.Plast Reconst Surg2014;134(2):259-273. doi:10.1097/PRS.0000000000000529Sohng C, Han MH, Park D, Park KD, Jang YH, Lee WJ,et al.Clinical features of subungual melanoma according to the extent of Hutchinson’s nail sign: a retrospective single-centre study.J Eur Acad Dermatol Venereol. 2021 Feb;35(2):380-386. doi:10.1111/jdv.16762Reilly DJ, Aksakal G, Gilmour RF, et al.Subungual melanoma: Management in the modern era.J Plas Reconstr Aesthet Surg. 2017;70(12):1746-1752. doi:10.1016/j.bjps.2017.08.001American Academy of Dermatology.How to check your nails for melanoma.Wollina U, Nenoff P, Haroske G, Haenssle HA.The diagnosis and treatment of nail disorders.Dtsch Arztebl Int. 2016;113(29-30):509-18. doi:10.3238/arztebl.2016.0509Starace M, Alessandrini A, Brandi N, Piraccini BM.Use of nail dermoscopy in the management of melonychia: review.Dermatol Pract Concept.2019;9(1):38-43. doi:10.5826/dpc.0901a10Holman BN, Van Gulick RJ, Amato CM, MacBeth ML, Davies KD, Aisner DL,et al.Clinical and molecular features of subungual melanomas are site-specific and distinct from acral melanomas.Melanoma Res. 2020;30(6):562-573. doi:10.1097/CMR.0000000000000688Liu WF, Yang FJ, Niu XH, Sun Y, Huang Z, Jin T,et al.Predictive value of sentinel lymph node biopsy in prognosis of acral melanoma.Chinese Journal of Oncology. 2021;43(1):147-154. doi:10.3760/cma.j.cn112152-20200702-00620
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Chakera AH, Quinn MJ, Lo S, et al.Subungual melanoma of the hand.Ann Surg Oncol. 2019;26(4):1035-1043. doi:10.1245/s10434-018-07094-wVasudevan B, Rana V, Mitra D, Neema S, Verma R, Kakkar S.A rare case of subungual melanoma.Indian J Dermatol. 2015;60(2):188. doi:10.4103/0019-5154.152526Gupta AK, Bharadwaj M, Mehrotra R.Skin cancer concerns in people of color: risk factors and prevention.Asian Pac J Cancer Prev. 2016;17(12):5257-5264. doi:10.22034/APJCP.2016.17.12.5257LaRocca CJ, Lai L, Nelson RA, Modi B, Crawford B.Subungual melanoma: a single institution experience.Medical Sciences. 2021;9(3):57. doi:10.3390/medsci9030057Cochran AM, Buchanan PJ, Bueno RA, Neumeister MW.Subungual melanoma: a review of current treatment.Plast Reconst Surg2014;134(2):259-273. doi:10.1097/PRS.0000000000000529Sohng C, Han MH, Park D, Park KD, Jang YH, Lee WJ,et al.Clinical features of subungual melanoma according to the extent of Hutchinson’s nail sign: a retrospective single-centre study.J Eur Acad Dermatol Venereol. 2021 Feb;35(2):380-386. doi:10.1111/jdv.16762Reilly DJ, Aksakal G, Gilmour RF, et al.Subungual melanoma: Management in the modern era.J Plas Reconstr Aesthet Surg. 2017;70(12):1746-1752. doi:10.1016/j.bjps.2017.08.001American Academy of Dermatology.How to check your nails for melanoma.Wollina U, Nenoff P, Haroske G, Haenssle HA.The diagnosis and treatment of nail disorders.Dtsch Arztebl Int. 2016;113(29-30):509-18. doi:10.3238/arztebl.2016.0509Starace M, Alessandrini A, Brandi N, Piraccini BM.Use of nail dermoscopy in the management of melonychia: review.Dermatol Pract Concept.2019;9(1):38-43. doi:10.5826/dpc.0901a10Holman BN, Van Gulick RJ, Amato CM, MacBeth ML, Davies KD, Aisner DL,et al.Clinical and molecular features of subungual melanomas are site-specific and distinct from acral melanomas.Melanoma Res. 2020;30(6):562-573. doi:10.1097/CMR.0000000000000688Liu WF, Yang FJ, Niu XH, Sun Y, Huang Z, Jin T,et al.Predictive value of sentinel lymph node biopsy in prognosis of acral melanoma.Chinese Journal of Oncology. 2021;43(1):147-154. doi:10.3760/cma.j.cn112152-20200702-00620
Chakera AH, Quinn MJ, Lo S, et al.Subungual melanoma of the hand.Ann Surg Oncol. 2019;26(4):1035-1043. doi:10.1245/s10434-018-07094-w
Vasudevan B, Rana V, Mitra D, Neema S, Verma R, Kakkar S.A rare case of subungual melanoma.Indian J Dermatol. 2015;60(2):188. doi:10.4103/0019-5154.152526
Gupta AK, Bharadwaj M, Mehrotra R.Skin cancer concerns in people of color: risk factors and prevention.Asian Pac J Cancer Prev. 2016;17(12):5257-5264. doi:10.22034/APJCP.2016.17.12.5257
LaRocca CJ, Lai L, Nelson RA, Modi B, Crawford B.Subungual melanoma: a single institution experience.Medical Sciences. 2021;9(3):57. doi:10.3390/medsci9030057
Cochran AM, Buchanan PJ, Bueno RA, Neumeister MW.Subungual melanoma: a review of current treatment.Plast Reconst Surg2014;134(2):259-273. doi:10.1097/PRS.0000000000000529
Sohng C, Han MH, Park D, Park KD, Jang YH, Lee WJ,et al.Clinical features of subungual melanoma according to the extent of Hutchinson’s nail sign: a retrospective single-centre study.J Eur Acad Dermatol Venereol. 2021 Feb;35(2):380-386. doi:10.1111/jdv.16762
Reilly DJ, Aksakal G, Gilmour RF, et al.Subungual melanoma: Management in the modern era.J Plas Reconstr Aesthet Surg. 2017;70(12):1746-1752. doi:10.1016/j.bjps.2017.08.001
American Academy of Dermatology.How to check your nails for melanoma.
Wollina U, Nenoff P, Haroske G, Haenssle HA.The diagnosis and treatment of nail disorders.Dtsch Arztebl Int. 2016;113(29-30):509-18. doi:10.3238/arztebl.2016.0509
Starace M, Alessandrini A, Brandi N, Piraccini BM.Use of nail dermoscopy in the management of melonychia: review.Dermatol Pract Concept.2019;9(1):38-43. doi:10.5826/dpc.0901a10
Holman BN, Van Gulick RJ, Amato CM, MacBeth ML, Davies KD, Aisner DL,et al.Clinical and molecular features of subungual melanomas are site-specific and distinct from acral melanomas.Melanoma Res. 2020;30(6):562-573. doi:10.1097/CMR.0000000000000688
Liu WF, Yang FJ, Niu XH, Sun Y, Huang Z, Jin T,et al.Predictive value of sentinel lymph node biopsy in prognosis of acral melanoma.Chinese Journal of Oncology. 2021;43(1):147-154. doi:10.3760/cma.j.cn112152-20200702-00620
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