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What Is a Toenail Melanoma?

Toenail discoloration is one symptom of a toenail melanoma.
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  • Written By: Jillian O Keeffe
  • Edited By: Shereen Skola
  • Last Modified Date: 25 November 2014
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Melanoma is a serious type of skin cancer, and one of the unusual places it may originate is the skin under the toenail. Most common in people with dark skin, toenail melanoma can affect any nail on the foot. Indications that a toenail is affected by melanoma include a dark spot or streak on the nail, or an uncolored growth under the nail.

Healthy skin contains melanocyte cells that produce a substance called melanin, which is responsible for the variation in skin tone of different races of people. It is a pigment, which means it gives color to a tissue, in this case, a brown color. Sun exposure in paler people triggers an increase in melanin production, which darkens the skin as a defense against ultraviolet damage from the sun's rays. When this defensive mechanism becomes damaged, perhaps through excessive sun exposure, the melanocytes, which are dark from melanin stores, grow out of control.

Three different types of cancer can cause a toenail melanoma. Most commonly, it is due to acral lentiginous melanoma, but nodular melanoma or desmoplastic melanoma may also be responsible. Whatever the exact cause, any cancer that occurs in the nails is called subungual melanoma. Basically, this is an overgrowth of melanocytes in the tissues relating to the nail.

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People with the condition may notice an abnormal coloration on their toenail. Commonly, a dark spot on the nail appears, which may be brown, black or purple. The cancer may look identical to damage caused by injury to the nail, so a person with it may not immediately spot the significance of the nail coloration. Often, the dark coloration appears as a streak that can stretch vertically down the nail.

Toenail melanoma does not always involve colored nail spots, and often the condition appears simply as a lump under the nail. The growth of the melanocytes can split the nail, or raise it up from the skin underneath. Generally, the cancer does not produce pain in the toenail area, but the cells may bleed or weep.

As the toenail that is most affected by toenail melanoma is on the great toe, scientists think that physical trauma to the nail may increase the risk of this type of melanoma developing. Possible treatment options include surgical removal of the cancer, amputation of the toe, or chemotherapy. Toenail melanoma is relatively uncommon in light-skinned people, but is responsible for up to half the cases of melanoma in people of African or Asian descent. Famed musician Bob Marley's cause of death was melanoma that began in the toenail.

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serenesurface
Post 3

I think part of the reason why melanomas get diagnosed late is because doctors don't want to do a biopsy unless it's necessary. Of course late diagnosis also has to do with the fact that people don't pay attention to their toes very much and toenail melanoma is not all that common.

But the other reason is that doctors don't want to do a biopsy because a biopsy can actually spread the melanoma. I had a very hard time convincing my doctor to do a biopsy. He finally removed the spot entirely and tested it. Thankfully, it turned out to be non-cancerous.

donasmrs
Post 2

@simrin-- Is the discoloration round or like a streak? Does the spot grow out with the nail or does it stay put? If it grows out, it's just a bruise, but if it stays put, it might be melanoma.

You can't know for sure without a biopsy though. So you should see your doctor right away. If your doctor also feels that it is similar to a melanoma discoloration, you will be sent to a specialist who can do a biopsy.

Don't jump to conclusions without a diagnosis, because it might just be a harmless bruise from your injury.

SteamLouis
Post 1

I hit my large toe some weeks ago and bruised it which caused a dark discoloration in my nail. It has been three weeks and the discoloration is still there.

Should I be worried? Could it be a toenail melanoma?

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