Unveiling Subungual Melanoma: Key Insights

Subungual melanoma is a rare but aggressive form of skin cancer that develops beneath the nails, specifically in the nail matrix or nail bed.

Despite its rarity, subungual melanoma carries significant importance due to its potential to metastasize quickly if not diagnosed and treated promptly.

It accounts for a small percentage of all melanoma cases, with a higher prevalence among individuals with darker skin tones.

The impact of subungual melanoma on health can be severe, leading to disfigurement, functional impairment, and in advanced cases, metastasis to other organs.

In its early stages, subungual melanoma is often asymptomatic, making it challenging to detect without regular screenings. However, as the disease progresses, symptoms such as changes in nail pigmentation, nail deformities, and nail detachment may occur.

The long-term health risks of untreated subungual melanoma include metastasis to lymph nodes and other organs, significantly reducing survival rates.

Therefore, early detection through regular skin checks and seeking medical attention for any suspicious nail changes is crucial to improving outcomes.

Causes of Subungual Melanoma

• Subungual melanoma can be caused by various factors, both intrinsic and extrinsic. The primary causes include genetic predisposition, chronic trauma or injury to the nail, exposure to ultraviolet (UV) radiation, and certain pre-existing skin conditions.

• Genetic mutations, especially in genes associated with melanoma development, can increase the risk of subungual melanoma over time. Chronic trauma or repeated injury to the nail matrix can trigger abnormal cell growth, leading to melanoma formation.

• Exposure to UV radiation, either from sunlight or artificial sources like tanning beds, is a well-known risk factor for melanoma, including subungual melanoma.

• Individuals with fair skin or a history of sunburns are at higher risk due to UV-induced DNA damage. Pre-existing skin conditions such as nail dystrophy or chronic infections can create an environment conducive to melanoma development.

• Secondary risk factors like smoking, poor nail hygiene, and occupational exposure to chemicals can also contribute to the risk of subungual melanoma.

Symptoms of Subungual Melanoma

Early-stage symptoms of subungual melanoma may include changes in nail pigmentation, such as dark bands or streaks, nail thickening, or nail deformities. These symptoms can impact daily activities by causing discomfort or affecting the aesthetics of the nail.

However, they are often mistaken for benign conditions like fungal infections, delaying diagnosis. Advanced-stage symptoms may involve nail ulceration, bleeding, or the formation of nodules under the nail.

These symptoms can significantly affect physical well-being and emotional health by causing pain, anxiety, and functional limitations.

Diagnosis of Subungual Melanoma

Diagnosing subungual melanoma typically involves a multi-step approach to confirm the presence of cancer and determine its stage.

Tests such as dermoscopy, nail matrix biopsy, imaging studies like ultrasound or MRI, and sentinel lymph node biopsy are commonly used to establish a diagnosis.

Dermoscopy allows for detailed examination of nail pigmentation patterns, while nail matrix biopsy provides tissue samples for histopathological analysis. Imaging studies help evaluate the extent of cancer spread, while sentinel lymph node biopsy identifies potential metastasis to lymph nodes.

Treatment Options for Subungual Melanoma

Treatment options for subungual melanoma vary depending on the disease stage and individual patient factors. Surgical excision of the affected nail unit or amputation of the finger may be necessary to remove the cancerous tissue completely.

In some cases, Mohs micrographic surgery is used to ensure precise removal of cancer cells while preserving healthy tissue. Adjuvant therapies like chemotherapy, immunotherapy, or targeted therapy may be recommended for advanced cases or to prevent disease recurrence.

Lifestyle modifications such as sun protection and regular nail inspections are essential to prevent future melanoma development.