If you’re an avid skier, snowboarder, soccer player, or have a tendency to stub your toe, you won’t be a stranger to the dark brown bleeding beneath the surface of your nail that we medically refer to as a subungual haematoma.
But with New Zealand having one of the highest rates of melanoma in the world, with approximately 4,000 people diagnosed each year and with melanoma accounting for nearly 80% of all skin cancer deaths, do you know how to spot it when it’s beneath your toenail – or did you realise that it can occur beneath your toenail?
It absolutely can, and here’s what you should know.
What is a melanoma?
A melanoma is a type of skin cancer that develops from the cells in the skin that produces pigment – the colour of our skin – called melanocytes. When these normal cells divide uncontrollably, melanoma can occur quite quickly. This means it can start as a small spot and grow to be serious in as little as six weeks.
If you’re wondering why these cells grow uncontrollably, Melanoma New Zealand describes it as the “cells in the body don’t obey the “instructions” about how to divide, how to grow and when to die. This happens when the genetic information in the cells is damaged, for example by exposure to the sun and damaging ultraviolet (UV) rays. When this happens, cells don’t die (to be replaced with new cells) when they are supposed to, and they grow and divide more rapidly than they are supposed to”.
What are the signs of a melanoma?
The signs of a melanoma beneath the toenail are the same as the signs of a melanoma anywhere else in your body. You want to look for asymmetry, an irregular border, colour, difference compared with normal moles, change or evolution, firmness and growth. Here’s what we mean, using the analogy ABCDEFG:
- Asymmetry: melanomas are more likely to be asymmetrical or have an irregular shape, compared with a normal mole or freckle with a symmetrical shape.
- Border: they are also more likely to have an irregular or jagged or poorly defined border; normal moles have smoother, clear borders.
- Colour: melanomas tend to be multicoloured with different colours or shades rather than being all one colour. They may be brown with black, red, pink, white or blue tints, while normal moles and freckles are usually just brown.
- Different: it may look different from other lesions, sometimes called the ‘ugly duckling’.
- Evolving: harmless moles usually stay the same size, shape and colour for many years, but melanomas change size, shape and colour.
- Firm: to the touch
- Growing: most are larger than 6 mm and keep growing.
When we look at melanomas beneath the toenail specifically, we may notice:
- Brown or black streaks in the nail without any known injury
- Streaks on the nails that increase in size
- A bruise on the nail that will not heal or move up as the toenail grows
- Toenails that separate from the nail bed
- Darkening skin next to the nail
- A nail that bleeds or develops a nodule
- Thinning, cracking, or distortion of the nail plate
One of the key indications of subungual melanoma is “Hutchinson’s sign.” This is when a person has nail pigment that extends onto the skin surrounding the nail.
What should you do if you notice a spot beneath your toenail?
First – avoid painting your toenails so that the toe can be easily examined. Next, you can book in either directly with your dermatologist, or one of our experienced podiatrists first to seek their professional opinion. While we won’t be able to diagnose your melanoma, we can discuss it with you and provide advice on your options and next steps. We understand how concerning having a spot beneath the nail can be, so we are here to help.