oenail melanoma

How to Tell If You Have a Toenail Melanoma

As you may have read, I have been trying to create a website where I can help people suffering from problems with their feet.  I have Plantar Fasciitis and found that the majority of the information out there was too medical or in language I didn't understand - so I am trying to put that right to help as many people as I can.

During my research, I came across this topic, which scared me!

Simply knowing this information could help save someone's life!

If you have noticed a dark, bruised looking spot or streak on your toenail, keep an eye on it as it is possibly a melanoma.

These toenail or thumbnail melanomas are pretty much the same type that is found on any part of your skin, but they have grown underneath your nail. If you have spent many years wearing nail polish, or not taking too much notice of your toes, it is possible that you have missed such a symptom completely.

Because you don't always just sit, looking at your toenails all the time, the problem is caught later than it should be, which can increase any problems.

What causes toenail melanoma?

Most melanomas are related to skin cancer and therefore they can be attributed to spending too much time in the sun, or not using sun creams properly, or even at all.

But, a toenail melanoma is not caused in this way - in fact, there are no conclusive explanations as to why they may occur.  Some doctors think they might be caused by damage to the toe or nail.

How are they diagnosed?

Proper diagnosis is done by taking a small biopsy of the tissue from under the nail.

This is done by punching or drilling through the nail and taking a sample from an affected area.  It is done under local anaesthetic and does not take long to perform.

The sample is then examined by a Dermatopathologist who will be able to make an informed diagnosis.

This is not something you can diagnose yourself, so please see a doctor as soon as possible if you think you may have this problem.

What is the treatment?

Unfortunately, research shows that treatment or removal of most toenail melanomas is done whilst they are in a later stage of growth.  These are technically tumors but are often benign, meaning that they can be removed quite quickly and easily with surgery.

However, one thing to note is that because it is covered by a nail, the toe or thumbnail will most likely be partially or completely removed to allow access to the affected area.

The surgery should only last for around an hour and it will be completed under local aesthetic, meaning a lengthy stay in hospital is not likely unless there are complications from the surgery.

If there is cancer, your doctor may follow up with chemotherapy or radiotherapy.

Is a toenail melanoma rare?

Looking at the statistics, this type of problem is quite uncommon, affecting 1 in 120 for men and 1 in 95 for women.  Other statistics show that it only accounts for 0.7% and 3.5% of all melanoma cases.

Some research published in 2010 revealed that in the UK, there were over 8500 new cases treated per year.

Toenail Melanoma Symptoms.

  • Skin that is darker or is darkening next to the nail.
  • A nail that bleeds for no reason or develops a "bump" or raised area.
  • Cracking or splitting nails (can also be related to nail fungus).
  • If you have a nail that comes away from the "nail bed" without any physical trauma or injury to that nail or toe.
  • Purple, brown or black spots, marks, streaks, lines or patches know as Melanonychia.
  • Any type of marking that increases in size.
  • A mark that looks like a bruise, but does not move with the nail as it grows or changes shape over time.

The most common symptom of this sort of cancer is when a small, dark spot can be seen under the toenail. You may mistake this for a normal mole as they look very similar. They can be either brown, dark brown, black or even yellow, resembling a bruise.

One common symptom is where you have a dark line that stretches from the tip of the nail to the cuticle.  This is also known as a "Hutchinson's sign".

In a rare number of cases, the melanoma spot has not unusual color at all, making it hard to spot. Unfortunately, these are often not detected soon enough and can be dangerous if they are malignant growths.

Research and medical studies have revealed that this sort of melanoma is more common in Asian and darker-skinned people, but it is also possible for Caucasians to be affected by this type of cancer too.

Does it cause your toes to hurt?

If the melanoma is newer, there could be no pain at all, unless your nail becomes damaged.  If the nail lifts from underneath, the toe and nail will become sore and will cause you some pain.

However, if the problem has not been spotted early, the cancerous cells can spread to the bones of your toes and this can cause quite a lot of pain.

What is a Subungal Melanoma?

The term "subungal" just means "under the nail" and is often used to describe a mark or problem that appears below the nail surface.

There are 3 main classifications or types for this disease that refer to the location of the melanoma:

  • Subungal - the issue is found in the nail bed or matrix and is under the nail.
  • Ungual - the melanoma grows from underneath the nail "plate".
  • Periungual - where the melanoma is found on the skin surrounding the edges of the toenail.

Toenail Melanoma Images.

toenail subungual melanoma

Source: http://diseasespictures.com/

toenail melanoma

Source: https://jfootankleres.biomedcentral.com/articles/10.1186/1757-1146-3-25

melanoma toe

Source: http://www.familienieuws.com

What should you do?

If you suspect that you have a nail melanoma, the first advice is not to panic. The possibility that the mole or mark is cancerous is quite low and the sooner you take action to investigate it, the better.

Start by making a note of the location and size of the spot - taking photographs is a good way to do this. If, whilst you are monitoring it over a few days, you can see that the spot has grown in size or changed color, there is a higher chance that it could be a melanoma.

The next step will be to make an appointment with your doctor and present your findings to him, asking for a referral to check if this spot is turning into a melanoma. It is likely that, in the absence of any other possible cause for the discoloration or mark, that you will be sent for a biopsy to confirm it's status.

Is it a melanoma or nail fungus?

toenail fungus example different from melanoma

Toenail fungus is a more common problem that you might experience, however, it is more easily identified compared to a melanoma.

Toenails that are infected usually become thicker, change size or shape, become lighter in color (yellow and brown) and have scaly, brittle edges.  They can have dark brown areas, but the infection usually affects more than one toe at the same time.

If the fungus does appear under the toenail, it is more likely to be a white patch that grows.  As the fungus spreads underneath, the toenail will most likely split and may fall off.

What about white streaks?

Another possible symptom to be aware of is noticing a white streak on your nails. Some people do have white marks on their nails, but this is usually due to some sort of damage that you may have done to it.  It is also more probable that any white marks or ridges on your nails are due to vitamin deficiency.

However, if you notice these white streaks, where you are certain you have not caused them through any other means, it is important to seek advice from your doctor as soon as possible.

It could also be a sign of toenail fungus or an infection.

Check your fingernails too.

It is also possible for nail melanomas to form on any nail - not just the big toenail, but on your fingernails too.

However, these do not appear as often on the fingernails as they do on the toes - but taking care to look after your nails and note any changes to them is important too.


If you notice any of these signs and symptoms, it is important that you make an appointment with a doctor as soon as possible. To put it bluntly, these melanomas are often non-cancerous (malignant) but they are cancer and are best investigated and treated as early as possible.

Early detection will increase the recovery rate and will put your mind at rest more quickly. Because a toenail melanoma is a type of cancer, it is also highly likely that a follow-up course of chemotherapy and radiation treatment will be completed.