Melanoma of the nails: What you need to know

Cancer of the nails – who knew there was such a thing? Not only can skin cancer affect the nail area, but nails can also develop their own specific type of melanoma. Though cancer on and around the fingernails and toenails is rare, there are some visual cues to be aware  of, and importantly, if you notice any of these, the sooner you get these checked out, the less risk of any possible melanoma spreading elsewhere. We talked to Professor Caitriona Ryan, Dermatologist at Institute of Dermatologists, Ireland (instituteofdermatologists.ie) about the signs we need to be aware of...

How common is cancer of the nails?

‘While still rare, squamous cell carcinoma (SCC) is the most common skin cancer of the nail,’ explained Caitriona. ‘Typically, it presents as a slowly growing warty mass on the nail border or under the nail that may ulcerate and bleed or cause lifting of the nail. It can move to the surrounding bone but metastases to other parts of the body are rare, and patients have a 99% 5-year survival.’ Melanoma of the nail is less common, Caitriona informs us, and accounts for only 0.7–3.5% of all melanomas (but up to 75% of melanomas in dark skinned individuals). ‘Africans, Asians, and native Americans (dark-skinned races) account for up to one-third of all cases. It is much more dangerous than SCC and the 5-year survival is only approximately 15%.’

What are the signs of nail melanoma? 

Just like we are encouraged to regularly check our skin for changes, the same is necessary for our nails. ‘Melanoma should be suspected when a single coloured band or streak arises in the nail in adulthood. The pigmented band is usually dark brown or black in colour, irregular and with a width of more than 3mm.’ The digit most commonly involved is the finger or thumb. ‘Extension of pigment onto the proximal or lateral nail fold (cuticle and skin surrounding the nail) is known as Hutchinson's sign and is very concerning for nail melanoma. A pigmented area under the nail that is associated with onycholysis  (which is when the nail detaches from the nail bed) and/or nail destruction is another sign. As is a pink nodule that frequently ulcerates and bleeds.’

How can we protect ourselves?

‘In the same way we protect our skin. Avoid UV damage and don’t use tanning beds.

Gel/acrylic/shellac manicures can cause UV damage to the skin and nails when UV lamps are used to cure and harden the gel polish. The UVA radiation from these lamps penetrates the skin leading to premature aging and an increased risk of skin cancer. Typically, nail salons now use LED lamps, which emit less UV radiation than traditional UV lamps but there is still some cumulative UV damage over time.’ If you do choose to have a treatment, ensure that you apply broad-spectrum UV on your fingers and hands before your treatment. ‘Try and spread out your nail treatments and use longer lasting polishes –Go to see your GP or dermatologist if you develop any change in colour of your nailbed, pigmented streaks or any lumps or painful areas under your nail.’

If we have been using UV lamps, is there anything we can do to reverse the damage?

‘The simple answer is no - there is no turning back the clock. But you can certainly minimise the damage going forward (as above).’

If you are concerned about any changes to your nails or the surrounding skin, please book an appointment to discuss this with your GP.