Subungual Melanoma is most easily defined as a cancer of the nail unit. Unlike other types of nail melanoma that grow in the surrounding skin, this type begins in the nail matrix. The nail matrix is a part of the nail bed that protects the underlying skin. Sometimes melanoma looks like other conditions that affect the nail bed, such as a bruise.
Within the medical community, Podiatrist Dallas, Tx also related to as Malignant Subungual Melanoma, Melanoma of Nail Matrix or Nail Matrix Melanoma.
Like most cancers, early detection is optimal. But, in the cases of subungal melanoma, it is often misdiagnosed as merely a fungal infection. The only way to confirm this type of cancer diagnosis is by a biopsy.
While subungual melanoma is a relatively rare condition compared to other skin cancers, it can lead to serious complications. Early detection and treatment is a must. It’s important to learn the signs of subungual melanoma so you can get help before the cancer spreads.
Causes of Subungual Melanoma
While we still don’t know what causes subungual melanoma, we do know many of the risk factors associated with its development. These include:
· Previous trauma to the fingers or toes (a common finding)
· Personal or family history of melanoma
· Multiple moles
· Trauma to the nail bed itself
· Bacterial or fungal infections of the nail bed
· Weakened immune systems due to immunosuppressant drugs or disease
· A familial history of melanoma or other related cancerous tumors
· Genetics, such as those with the hereditary condition xeroderma pigmentosa extreme sensitivity to UV radiation
· Immune suppression, including organ recipients and people with advanced HIV
The one thing that doesn’t appear to be a factor and differentiates it from all other types of melanoma is sun exposure. Ultraviolet (UV) radiation neither contributes to nor speeds the development of a subungual malignancy.
Of course, the term melanoma is often associated with a cause due to sun exposure. This isn’t the case with melanoma under the nail matrix. Current scientific research shows that sunlight does not seem to be a significant factor for Nail Unit Melanoma.
Symptoms of Subungual Melanoma
When you hear the word melanoma, your first thought might be irregular-shaped moles on the skin caused by sun damage. But since subungual melanoma affects the nail matrix, the signs and symptoms don’t look like a typical mole on the skin.
There are some visual clues unique to Subungual Melanoma. Unfortunately, late detection is problematic as it can be masked by other factors such as injury, hematomas, or fungal infection, but outlined below are some observational highlights to be concerned with.
Symptoms of this condition include:
· a light- to dark-brown colored band on the nail that’s usually vertical
· a dark band on the nail that slowly expands and covers more of the nail
· dark nail pigmentation that expands to the surrounding skin
· a nodule underneath the nail with or without a pigmentation band
· nail brittleness and cracking
· bleeding at the site of pigmentation
It’s important to note that not all cases of this condition cause pigmentation changes in the nail. While this can make the melanoma more challenging to detect, a telltale sign of the condition is that it usually affects one nail at a time.
Diagnosis of Subungual Melanoma
Subungual melanoma is difficult to detect on your own. As a rule of thumb, you should see Podiatrist Dallas, Tx right away if you notice any unusual changes or growths in your nail.
A diagnosis of subungual melanoma will usually 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 other, more common conditions, such as:
- Subungual hematoma, a bruising beneath the nail which lacks the uniformity of subungual melanoma
- Fungal infections onychomycosis which more often have dark, non-longitudinal stripes accompanied by yellow or white streaks
- Moles nevi, which are less likely to appear in streaks
- Deposits of melanin beneath the nail which can occur as a result of pregnancy as well as chemotherapy or radiation therapy
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
Complications of subungual 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 from carcinoma in situ pre-cancer all the way to stage four metastatic disease where cancer has spread to other organs.
Podiatrist Dallas, Tx 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.
