What Is Subungual Melanoma?

Written by Medicover Team and Medically Reviewed by Dr Karimi Prashob Kumar , Oncologist

---

Subungual melanoma is a rare and aggressive form of skin cancer that develops beneath the fingernails or toenails. Often mistaken for a bruise, fungal infection, or injury, it typically appears as a dark streak or discoloration under the nail. This condition can go unnoticed in its early stages, making timely diagnosis critical.

Subungual melanoma most commonly affects the thumb or big toe and can occur in people of all skin tones. Understanding its symptoms and seeking prompt medical attention can significantly improve treatment outcomes. In this article, we'll explore the causes, symptoms, and treatment options for subungual melanoma.

What are the Symptoms of Subungual Melanoma?

Subungual melanoma can present with various symptoms that may initially go unnoticed or be misdiagnosed. The most common sign is a pigmented band or stripe under the nail, particularly when it extends onto the surrounding skin, known as Hutchinson's sign.

This cancer often starts subtly but may become more evident as it grows. Changes in nail color or texture, discomfort, or visible streaks are common signs that require medical attention. The earlier these symptoms are evaluated, the better the treatment outcomes will be.

Visual Indicators

Sensory Symptoms

Patients may also report pain or tenderness in the affected nail. These symptoms often suggest more advanced disease and require immediate medical evaluation to improve outcomes.

---

What are the Causes and Risk Factors of Subungual Melanoma?

Subungual melanoma can arise from a combination of genetic, environmental, and demographic factors. Understanding these helps in early detection and prevention strategies.

Various influences contribute to this condition, including genetics, trauma, and other predisposing factors. Recognising and minimising these risks can support the prevention and early diagnosis of these conditions.

Genetic Factors

Gene mutations, such as those in the BRAF, NRAS, and KIT genes, have been linked to an increased risk of melanoma. Individuals with a family history of melanoma may have a genetic predisposition, making routine skin checks more important.

Environmental and Lifestyle Factors

Though not as strongly linked to UV radiation as other types of melanoma, chronic nail trauma, irritation, and immunosuppression are notable risk factors. Repeated injury or pressure to the nails can contribute to cellular changes leading to cancer.

Demographic Factors

Subungual melanoma is more common in individuals aged 50-70 and slightly more prevalent in males. It affects all races but is more frequently observed in those with darker skin tones, often appearing on the thumb or big toe.

---

How is Subungual Melanoma Diagnosed?

Early and accurate diagnosis of subungual melanoma significantly improves treatment outcomes. Diagnosis typically involves a combination of visual inspection, imaging, and tissue analysis.

Healthcare providers use various methods to determine the presence of this cancer. Clinical evaluation and specialized diagnostic tools help distinguish it from other nail disorders.

Clinical Examination

A dermatologist evaluates the nail for suspicious features, including its width, colour, and the location of any pigmentation. The presence of Hutchinson's sign is a key diagnostic clue.

Dermoscopy

Dermoscopy enables the magnified visualisation of the nail unit, facilitating the distinction between subungual melanoma and benign nail conditions, such as hematoma or fungal infection.

Biopsy

A biopsy is necessary for a definitive diagnosis. Tissue is taken from the nail matrix and analysed under a microscope to confirm the presence of melanoma and determine its characteristics.

---

What is the Prognosis and Staging of Subungual Melanoma?

Understanding the stage of melanoma is crucial for treatment planning and assessing prognosis. The American Joint Committee on Cancer (AJCC) staging system is often used.

Staging guides the treatment approach and helps predict outcomes. Early detection typically leads to a better prognosis, while later stages may require more aggressive interventions.

Staging

Melanoma staging considers tumor thickness, ulceration, lymph node involvement, and metastasis. Stages range from 0 (in situ) to IV (distant metastasis).

Prognosis Factors

The prognosis depends on early detection, tumor thickness, ulceration, and lymph node involvement. Early-stage subungual melanoma has a favorable prognosis, while advanced stages require aggressive treatment and have lower survival rates.

---

What are the Treatment Options for Subungual Melanoma?

Treatment of subungual melanoma involves surgical removal and may include additional therapies based on the stage and spread of the disease.

Each treatment plan is customised to the patient's stage and overall health. The main goal is to remove cancerous tissue and prevent recurrence or metastasis.

Surgical Treatment

Surgery is the cornerstone of treatment. Procedures may include excision of the nail, nail bed, and sometimes amputation of the digit to achieve clear margins and prevent recurrence.

Adjuvant Therapy

For more advanced stages, adjuvant therapies such as immunotherapy, targeted therapy, or chemotherapy may be used to eliminate residual cancer cells and reduce the risk of metastasis.

Follow-up and Monitoring

Post-treatment monitoring includes regular skin and nail exams, imaging studies, and blood tests. Lifelong follow-up is recommended to detect recurrence early.

---

What is the Recovery Process After Subungual Melanoma Treatment?

Recovery varies depending on the extent of the surgery and any additional treatments required. Healing typically involves wound care, physical rehabilitation, and regular medical check-ups.

Patients may need temporary or permanent lifestyle adjustments, especially after finger or toe amputation. Support services and rehabilitation can significantly enhance long-term recovery and overall function.

---

What are the Prevention and Risk Reduction Strategies?

While subungual melanoma cannot always be prevented, certain measures can lower the risk and support early detection.

These practices can help catch the disease in its early stages when treatment is most effective and the prognosis is better.

---

What are the Potential Complications of Subungual Melanoma?

Complications arise when diagnosis or treatment is delayed. These may include:

Timely and appropriate management reduces the likelihood of serious complications and improves the quality of life for patients.

---

When Should You See a Doctor for Subungual Melanoma?

Consult a healthcare provider if you notice unusual changes in your nails, such as persistent discolouration, streaks, bleeding, or pain. These signs may indicate subungual melanoma or other serious nail conditions. Early evaluation by a dermatologist can facilitate timely diagnosis and treatment, improving the likelihood of a positive outcome.

---

Our Experience in Treating Subungual Melanoma

At Medicover, we combine advanced diagnostics and personalized care to manage subungual melanoma with precision. Our team of experienced dermatologists and oncologists ensures that patients receive timely intervention, surgical expertise, and long-term support. We are committed to guiding you through every step, from diagnosis to recovery, with compassion and care.

---