What are the common types of nail abnormalities. How can changes in nail appearance indicate underlying health issues. What causes nail problems and deformities. How are various nail conditions diagnosed and treated. When should you see a doctor for nail abnormalities.

Understanding Nail Structure and Function

Nails are an essential part of our body’s protective system, shielding the sensitive tips of our fingers and toes. They are composed primarily of keratin, a protein also found in hair and skin. Understanding the basic structure of nails is crucial for recognizing abnormalities:

• Nail plate: The visible part of the nail
• Nail bed: The skin beneath the nail plate
• Nail matrix: The area at the base of the nail where new cells are produced
• Cuticle: The thin layer of skin that protects the nail root
• Lunula: The white, crescent-shaped area at the base of the nail

Healthy nails typically have a smooth, consistent color and texture. Any changes in these characteristics can be indicative of various health issues or external factors affecting nail growth.

Common Types of Nail Abnormalities

Nail abnormalities can manifest in various ways, affecting the color, shape, texture, or thickness of fingernails and toenails. Here are some of the most common types:

Beau’s Lines

These are horizontal depressions across the fingernail. They can occur after illness, injury to the nail, eczema around the nail, during chemotherapy, or due to nutritional deficiencies. Do Beau’s lines always indicate a serious health problem? Not necessarily. While they can be associated with systemic illnesses, they may also result from temporary disruptions in nail growth due to minor injuries or stress.

Koilonychia (Spoon Nails)

This condition is characterized by abnormally shaped fingernails that are thin and curved inward, resembling a spoon. It is often associated with iron deficiency anemia. Can koilonychia be reversed? In many cases, yes. Treating the underlying iron deficiency often leads to improvement in nail appearance.

Onycholysis

Onycholysis refers to the separation of the nail from the nail bed. This can make nails appear white or opaque and can lead to debris accumulation beneath the nail. Is onycholysis painful? Generally, onycholysis itself is not painful, but it can make the nail more susceptible to infection, which may cause discomfort.

Leukonychia

This condition presents as white streaks or spots on the nails. It can be caused by various factors, including minor injuries, medications, or underlying diseases. Are all white spots on nails a sign of calcium deficiency? Contrary to popular belief, most white spots on nails are not related to calcium deficiency but are often the result of minor trauma to the nail.

Causes of Nail Abnormalities

Nail abnormalities can arise from a wide range of causes, both internal and external. Understanding these causes is crucial for proper diagnosis and treatment:

Injuries and Trauma

Physical damage to the nail or surrounding tissue can lead to various abnormalities:

• Crushing injuries at the base of the nail can cause permanent deformity
• Chronic picking or rubbing of the skin behind the nail may result in median nail dystrophy
• Long-term exposure to moisture or nail polish can make nails brittle and prone to peeling

Infections

Various microorganisms can infect the nail and surrounding tissues, leading to changes in nail appearance and health:

• Fungal infections can alter the color, texture, and shape of nails
• Bacterial infections may cause discoloration or painful areas under the nail
• Viral warts can change the nail shape or cause ingrown skin under the nail

How can you distinguish between fungal and bacterial nail infections? Fungal infections typically cause thickening, discoloration, and crumbling of the nail, while bacterial infections often result in redness, swelling, and pain in the surrounding skin.

Systemic Diseases

Many internal health conditions can manifest as nail abnormalities:

• Psoriasis can cause nail pitting and discoloration
• Diabetes may lead to yellowing of the nails
• Liver and kidney diseases can cause nail clubbing
• Anemia often results in pale, concave nails (koilonychia)

Diagnosing Nail Abnormalities

Proper diagnosis of nail abnormalities is essential for effective treatment. Healthcare providers use various methods to identify the underlying causes:

Visual Examination

A thorough visual inspection of the nails is often the first step in diagnosis. Dermatologists and other specialists look for changes in color, shape, texture, and the surrounding skin. What specific features do doctors look for during a nail examination? They assess the nail plate for discoloration, thickening, or separation from the nail bed. They also examine the cuticle, nail folds, and surrounding skin for signs of inflammation or infection.

Medical History

A comprehensive medical history helps identify potential systemic causes or risk factors for nail abnormalities. This includes information about:

• Recent illnesses or chronic health conditions
• Medications and supplements
• Occupational exposures
• Family history of nail or skin disorders

Laboratory Tests

In some cases, additional tests may be necessary to confirm a diagnosis:

• Nail clippings for fungal culture
• Blood tests to check for nutritional deficiencies or systemic diseases
• Nail biopsy in cases of suspected malignancy

When is a nail biopsy typically recommended? Nail biopsies are usually reserved for cases where there’s suspicion of a serious condition like melanoma, or when other diagnostic methods have been inconclusive.

Treatment Options for Nail Abnormalities

Treatment for nail abnormalities varies depending on the underlying cause and severity of the condition. Here are some common approaches:

Topical Treatments

Many nail conditions can be addressed with topical medications:

• Antifungal creams or lacquers for fungal infections
• Corticosteroid creams for inflammatory conditions
• Moisturizing treatments for brittle nails

How long does it typically take to see results from topical nail treatments? The timeline can vary significantly depending on the condition and treatment. For fungal infections, it may take several months to see improvement, while other conditions might show results in a few weeks.

Oral Medications

In some cases, systemic treatment is necessary:

• Oral antifungals for severe fungal infections
• Antibiotics for bacterial infections
• Nutritional supplements to address deficiencies

Surgical Interventions

For certain nail conditions, surgical procedures may be recommended:

• Nail avulsion (removal) for severe infections or injuries
• Matricectomy to prevent regrowth of problematic nails
• Excision of tumors or warts affecting the nail

Is nail surgery always performed under general anesthesia? Most nail surgeries can be performed under local anesthesia as outpatient procedures, minimizing risks and recovery time.

Preventive Measures and Nail Care

Maintaining healthy nails involves a combination of good hygiene practices and preventive measures:

Proper Nail Hygiene

• Keep nails clean and dry
• Trim nails regularly and file them to prevent sharp edges
• Avoid biting nails or picking at cuticles
• Use moisturizer on nails and cuticles

Protective Measures

Taking steps to protect your nails can prevent many common problems:

• Wear gloves when working with water or chemicals
• Choose breathable footwear to prevent fungal infections
• Avoid sharing nail care tools with others
• Use caution when getting manicures or pedicures at salons

How often should you take a break from nail polish to maintain nail health? It’s generally recommended to give your nails a “breather” for a few days between polish applications to prevent discoloration and allow the nails to rehydrate.

Nutritional Support

A balanced diet rich in essential nutrients can promote nail health:

• Protein for keratin production
• Biotin and other B vitamins for nail strength
• Iron to prevent koilonychia
• Zinc for overall nail health

When to Seek Medical Attention

While many nail abnormalities are benign, some may require professional medical evaluation. Consider consulting a healthcare provider if you notice:

• Persistent changes in nail color or shape
• Pain, swelling, or redness around the nails
• Nails that separate from the nail bed
• Thickening or thinning of nails
• Dark streaks under the nail

Should you be concerned about every minor change in your nails? Not necessarily. Many minor nail changes are harmless and resolve on their own. However, if changes persist or are accompanied by other symptoms, it’s best to consult a healthcare professional for proper evaluation.

Understanding nail abnormalities and their potential causes can help you maintain better overall health and seek timely medical attention when necessary. By practicing good nail hygiene and being attentive to changes in your nails, you can often prevent or address nail problems before they become serious issues.

Nail abnormalities Information | Mount Sinai

Beau lines; Fingernail abnormalities; Spoon nails; Onycholysis; Leukonychia; Koilonychia; Brittle nails

Nail abnormalities are problems with the color, shape, texture, or thickness of the fingernails or toenails.

A paronychia is an infection around the nail. Many organisms can cause a paronychia. This particular case is caused by the yeast-like organism Candida. Note the inflammation (red, swollen area) at the base of the nail and the changes that are apparent in the nail itself.

Nails may exhibit many different abnormalities. In the condition known as koilonychia, the nails are flattened and have concavities. This condition may be associated with iron deficiency.

In onycholysis the nails become loose. They may even detach from the nail bed. When not held firmly in place, the nails are rapidly damaged and debris collects beneath them.

White nail syndrome may also be called leukonychia. Leukonychia can occur with arsenic poisoning, heart disease, renal failure, pneumonia, or hypoalbuminemia.

Yellow nail syndrome is characterized by yellow nails that lack a cuticle, grow slowly, and are loose or detached (onycholysis). Yellow nail syndrome is most commonly associated with lung disorders, and with lymphedema.

Internal diseases and nutritional deficits can cause changes in the appearance of the nails.

Yellow nails are seen in the ‘yellow nail syndrome’ in which there is thickening and yellow to yellow-green discoloration of all nails. Lymphedema, especially of the ankles, and compromised respiration may be present. The nails may also be over-curved both transversely and longitudinally. Lunulae and cuticles may also be lost.

Like the skin, the fingernails are a reflection of a person’s state of health. Low levels of zinc and iron as well as thyroid problems can cause brittle nails. However, brittle nails are often a normal result of aging.

Considerations

Like the skin, the fingernails tell a lot about your health:

• Beau lines are depressions across the fingernail. These lines can occur after illness, injury to the nail, eczema around the nail, during chemotherapy for cancer, or when you do not get enough nutrition.
• Brittle nails are often a normal result of aging. They can also be due to certain diseases and conditions.
• Koilonychia is an abnormal shape of the fingernail. The nail has raised ridges and is thin and curved inward. This disorder is associated with iron deficiency anemia.
• Leukonychia is white streaks or spots on the nails often due to drugs or disease.
• Pitting is the presence of small depressions on the nail surface. Sometimes the nail is also crumbling. The nail can become loose and sometimes falls off. Pitting is associated with psoriasis and alopecia areata.
• Ridges are tiny, raised lines that develop across or up and down the nail.

Causes

Injury:

• Crushing the base of the nail or the nail bed may cause a permanent deformity.
• Chronic picking or rubbing of the skin behind the nail can cause median nail dystrophy, which gives a lengthwise split or ridged appearance of the thumbnails.
• Long-term exposure to moisture or nail polish can cause nails to peel and become brittle.

Infection:

• Fungus or yeast cause changes in the color, texture, and shape of the nails.
• Bacterial infection may cause a change in nail color or painful areas of infection under the nail or in the surrounding skin. Severe infections may cause nail loss. Paronychia is an infection around the nailfold and cuticle.
• Viral warts may cause a change in the shape of the nail or ingrown skin under the nail.
• Certain infections (especially of the heart valve) may cause red streaks in the nail bed (splinter hemorrhages).

Diseases:

• Disorders that affect the amount of oxygen in the blood (such as heart problems and lung diseases including cancer or infection) may cause clubbing.
• Kidney disease can cause a build-up of nitrogen waste products in the blood, which can damage nails.
• Liver disease can damage nails.
• Thyroid diseases such as hyperthyroidism or hypothyroidism may cause brittle nails or splitting of the nail bed from the nail plate (onycholysis).
• Severe illness or surgery may cause horizontal depressions in the nails Beau lines.
• Psoriasis may cause pitting, splitting of the nail plate from the nail bed, and chronic (long-term) destruction of the nail plate (nail dystrophy).
• Other conditions that can affect the appearance of the nails include systemic amyloidosis, malnutrition, vitamin deficiency, and lichen planus.
• Skin cancers near the nail and fingertip can distort the nail. Subungual melanoma is a potentially deadly cancer that will normally appear as a dark streak down the length of the nail.
• Hutchinson sign is a darkening of the cuticle associated with a pigmented streak and may be a sign of an aggressive melanoma.

Poisons:

• Arsenic poisoning may cause white lines and horizontal ridges.
• Silver intake can cause a blue nail.

Medicines:

• Certain antibiotics can cause lifting of the nail from the nail bed.
• Chemotherapy medicines can affect nail growth.

Normal aging affects the growth and development of the nails.

Home Care

To prevent nail problems:

• DO NOT bite, pick, or tear at your nails (in severe cases, some people may need counseling or encouragement to stop these behaviors).
• Keep hangnails clipped.
• Wear shoes that do not squeeze the toes together, and always cut toenails straight across along the top.
• To prevent brittle nails, keep the nails short and do not use nail polish. Use an emollient (skin softening) cream after washing or bathing.

Bring your own manicure tools to nail salons and DO NOT allow the manicurist to work on your cuticles.

Using the vitamin biotin in high doses (5,000 micrograms daily) and clear nail polish that contains protein can help strengthen your nails. Ask your provider about medicines that help with abnormal-appearing nails. If you have a nail infection, you may be prescribed antifungal or antibacterial drugs.

When to Contact a Medical Professional

Call your health care provider if you have:

• Blue nails
• Clubbed nails
• Distorted nails
• Horizontal ridges
• Pale nails
• White lines
• White color under the nails
• Pits in your nails
• Peeling nails
• Painful nails
• Ingrown nails

If you have splinter hemorrhages or Hutchinson sign, see the provider immediately.

What to Expect at Your Office Visit

The provider will look at your nails and ask about your symptoms. Questions may include whether you injured your nail, if your nails are constantly exposed to moisture, or whether you are always picking at your nails.

Tests that may be ordered include x-rays, blood tests, or examination of parts of the nail or the nail matrix in the laboratory.

American Academy of Dermatology website. 12 nail changes a dermatologist should examine. www.aad.org/public/everyday-care/nail-care-secrets/basics/nail-changes-dermatologist-should-examine. Accessed July 23, 2021.

Andre J, Sass U, Theunis A. Diseases of the nails. In: Calonje E, Brenn T, Lazar AJ, Billings SD, eds. McKee’s Pathology of the Skin with Clinical Correlations. 5th ed. Philadelphia, PA: Elsevier; 2020:chap 23.

Tosti A. Diseases of hair and nails. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 413.

Last reviewed on: 6/19/2021

Reviewed by: Ramin Fathi, MD, FAAD, Director, Phoenix Surgical Dermatology Group, Phoenix, AZ. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

12 nail changes a dermatologist should examine

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Nail cancer – symptoms, treatments, prevention and diagnosis

Nail melanoma is a malignant tumor characterized by rapid growth and multiplication. The appearance of nail cancer is similar to a post-traumatic bruise. In this case, the thumb is considered the most common place of occurrence.

Development of nail melanoma

Primary nail melanoma is almost invisible. Outwardly, it is difficult to identify a malignant tumor, while the nail plate acquires a dark brown and dark blue color. Melanoma under the nail is also colorless due to a small amount of melanin. Nail cancer destroys the nail slowly. Melanoma of the nail does not leave the opportunity to recover. Timely detected melanoma under the nail makes it possible to prescribe treatment with greater efficiency. Melanoma of the big toe nail appears more often due to the presence of a weak point. Melanoma of the nail of the hand is accompanied by a change in the appearance of the fingers.

Causes

Melanoma under the nail is more common in the elderly. The true causes of nail cancer have not yet been identified. Factors affecting the appearance of nail melanoma:

• the presence of moles and warts;
• skin defects of fingers from birth;
• development of tumors in other organs and tissues;
• treated fungus or viral infection;
• regular injury to the site of nail melanoma;
• late treatment of injuries with antiseptics;
• UV burns;
• lack of melanin;
• heredity.

Among the likely causes of nail cancer is a violation of the principle of a healthy lifestyle – lack of sleep, lack of physical activity, malnutrition. All this contributes to a decrease in immunity, which allows the development of melanoma of the nail.

Types of nail melanoma

In the selection of adequate therapy for cancer under the nail is the definition of its type. According to the forms of nail cancer, the following types are distinguished:

• superficial – develops in a horizontal position;
• nodal – characterized by deep penetration and rapid spread;
• lentigo – differs from horizontal uneven staining;
• achromatic – characterized by a dark shade of nail melanoma;
• acrolentiginous – initially appears on the surface and gradually penetrates deep into, affecting, including lips, palms and fingers. There are three types depending on the location: nail matrix, plate, epidermis.

How the disease develops

Development stage nail melanoma has the following:

• initial stage nail melanoma is almost impossible to diagnose due to the absence of any manifestations and discomfort;
• Stage 2 is characterized by the appearance of nodules and penetration into the depths, as well as a change in color;
• Stage 3 occurs with damage to the lymph nodes and destruction of the nail;
• Stage 4 occurs with damage to other vital internal organs and severe pain.

Each stage of nail melanoma has its own signs and characteristics.

Symptoms

Symptoms of melanoma:

• separation of the nail plate and the appearance of a thickening in the form of a tubercle;
• discoloration of the nail plate for no apparent reason;
• the appearance of a longitudinal strip in the center of the nail;
• purulent discharge in advanced disease;
• throbbing pain in the affected area, first on pressure, then constant;
• detachment of the nail.

If there are several symptoms, the specialist correctly diagnoses melanoma of the toenail or handnail.

Diagnostics

Melanoma of the toenail or handnail does not allow to determine the disease by external signs. In the process of diagnosis, an anamnesis is collected and dermatoscopy is performed. Examination of melanoma of the nail on the leg or hand occurs with a magnifying glass or other magnifying device. Examining melanoma under the thumbnail is a difficult task. For an accurate diagnosis of toenail or handnail cancer, a biopsy is necessary, as well as blood sampling for tumor markers. With melanoma of the big toe on the leg or arm, the diagnosis is carried out by the following methods – urine and venous blood analysis, MRI, ultrasound of internal organs. The examination is carried out under the supervision of a dermatologist and an oncologist.

Contacting a specialist

In the oncological center “Sofia”, located in the center of Moscow, patients will be provided with the necessary medical care by dermatologists and oncologists trained in leading foreign clinics, as well as psychologists aimed at the correct perception of the diagnosis and the patient’s aspirations to a cure.

Here we are ready to offer you the most modern diagnostic methods that allow you to make an accurate diagnosis and start an adequate treatment. To diagnose melanoma of the toenail or hand, the following procedures are used – MRI, CT, SPECT, PET, radiography, fluoroscopy, ultrasound, laboratory tests.

Treatment

Thumbnail melanoma is the most common form of this disease. The only effective way to treat melanoma of the nail on the thumb and all other places is surgery to remove it.

There are several types of operations:

• a simple operation – the neoplasm itself is removed;
• cryotherapy is exposure to liquid nitrogen, effective in the initial stages;
• laser removal – carried out only in the initial stages of the disease.

Before surgery, it is necessary to undergo a course of chemotherapy, to stop the reproduction of malignant cells. And after surgery, a course of radiation therapy is needed to suppress the remaining atypical cells.

How to make an appointment with a doctor? Melanoma of the toenail or hand has more promising prospects due to the fact that the high qualifications and extensive experience of specialists make it possible to accurately diagnose and choose the best method of therapy.

Subungual melanoma, nail plate cancer: cure, symptoms, early stages of nail cancer

Subungual melanoma, or nail melanoma as some patients call it, is one of the rarest forms of malignant neoplasms. It develops in the area of ​​the nail bed, at first it looks like a dark or black spot or strip, the size of which gradually increases, affecting the nail fold, the phalanx bone and its soft tissues. The tumor is prone to an aggressive course, the results of treatment to date leave much to be desired. Above is a characteristic subungual melanoma in the photo – this is what this malignant tumor looks like.

Sometimes patients also use the term “nail cancer”, but this is an incorrect name for the disease. Cancer is called malignant tumors that develop from cells of epithelial tissues: skin, mucous membranes. Melanoma is a malignant tumor that originates from melanocyte pigment cells. Thus, in this case, “nail cancer” and “cancer under the nail” are incorrect terms.

By the way, “melanoma on the nail” is also wrong to say that. The tumor is not on the nail, but under it, it’s just visible through it.

Causes of subungual melanoma

Now that we have talked about what nail melanoma is and how to properly call it, let’s see why it occurs.

Unlike all other malignant tumors of the skin, with subungual melanoma, excessive insolation practically does not play any role as a provoking factor in the development of the disease. This is confirmed by the fact that the neoplasm often affects the toes, which are almost constantly covered by shoes. In addition, epidemiological data suggest that subungual melanoma is 40% more common in blacks and Mongoloids.

Possible risk factors for the development of melanoma in this localization include:

• Mechanical trauma to the nail. About a third of patients with an established diagnosis noted the presence of mechanical damage to the nail phalanx in history. Most often, the toes, as well as the thumb and forefinger of the working hand, suffer from this. In addition, cosmetic and surgical interventions that are performed for various nail diseases can provoke melanoma.
• Physical injuries – frostbite and burns, use of a laser to treat or remove damaged nails.
• Exposure to chemical carcinogens on nails. About 10% of patients had prolonged contact with chemicals (occupational hazard).
• Hereditary factor. About 5-14% of melanoma patients have genetic defects, in particular, mutations in the CDKN2A, CDK4, MITF, VC1R genes.
• A large number of dysplastic nevi. In the vast majority of cases, the development of subungual melanoma occurs de novo, i.e., on unchanged tissues, but the risks of its development are higher in individuals with a large number of pigmented dysplastic nevi.
• Age over 60.

Predisposing risk factors for melanoma in Caucasians are fair skin, red hair, and freckles.

Symptoms of subungual melanoma

Two stages of development are characteristic of subungual melanoma: horizontal and vertical.

In the horizontal stage, pigmented subungual melanoma appears as a brown or black streak under the nail. Its color may be uneven. In a third of patients, there is an expansion of pigmentation with involvement in the process of the free edge of the nail, nail fold and skin.

For pigmentless melanoma (which, by the way, occurs in 30% of cases), such signs are not typical, and the disease goes unnoticed for a long time. The first symptoms develop at the vertical stage, when the tumor begins to invasively grow into the surrounding tissues. At this time, the deformation of the nail occurs. The nail plate becomes dull, loses its natural shine. Its thickness becomes thinner, the nail becomes brittle, exfoliates and breaks easily. As the tumor increases in size, the nail cracks and a bumpy surface is revealed underneath. In the case of pigmentary melanoma, it will be brown or black with patches of more pigmented areas. With mechanical contact, this surface bleeds easily.

Does subungual melanoma hurt? In the early stages, the disease is not accompanied by any discomfort. In some cases, subungual melanoma is accompanied by a burning sensation, itching, or fullness. As the pathology progresses, the tumor involves new tissues in the process, spreading to the soft tissues of the fingers, feet or hands. The pain syndrome increases and the person cannot fully use the affected limb.

Systemic symptoms of melanoma include general weakness, weight loss, persistent fever. When metastasizing, symptoms from the affected organs join. The rate of progression of the disease is different for each patient. In some cases, several years pass, and in others, metastases are detected as early as a year after the primary occurrence of melanoma.

Subungual melanoma: when to worry? You need to see a doctor for any suspicious changes in the nail. Even if it turns out that they are not caused by a malignant tumor, but by another disease, in any case, it is better to start treatment in a timely manner.

In addition to melanoma, there is such a condition as cancer of the nail plate, in the medical language – onychomatricoma. She herself is hidden under the skin, but leads to changes in the nail.

Classification

• 0 stage, or melanoma in situ – the initial stage of melanoma of the nail. There is dysplasia or non-invasive malignant cell involvement.
• stage 1 – the thickness of melanoma is not more than 1 mm, or up to 2 mm, but without ulceration of the surface.
• Stage 2 melanoma is set if the thickness of the ulcerated tumor is more than 2 mm or more than 4 mm in the absence of ulceration of its surface.
• Stage 3 – any thickness of melanoma in the presence of metastases in regional lymph nodes.
• stage 4 – there are metastases in the internal organs.

Among the clinical and morphological types of tumors in the area of ​​the nail bed, as well as on the fingers, in the interdigital spaces, on the palms and soles, acral nail melanoma is often found. It is characterized by some specific features.

Diagnostic methods

Subungual melanoma refers to tumors of external localization, however, timely diagnosis can be difficult due to the similarity of the clinical picture with nevi, subungual hematomas and hemangiomas. To differentiate the nature of the neoplasm, special dermatological research methods are used:

• Dermatoscopy is a visual assessment of pathologically altered tissues using multiple magnification.
• Epiluminescence microscopy — dermoscopic examination of pathologically altered tissues in an immersion medium. This technique allows with a high degree of probability to differentiate a benign neoplasm from a malignant one.

If there are changes in the nail plate, a cytological examination of impression smears can be performed. The final diagnosis is made after the histological conclusion. In the case of melanoma, it is strongly not recommended to take a biopsy so as not to provoke metastasis. Therefore, the study is carried out after a radical surgical operation.

If subungual melanoma cannot be ruled out within two months after the patient’s visit, a marginal resection of the nail plate with matrixectomy is performed, followed by a histological examination of the obtained material. When the diagnosis is confirmed, radical surgery is indicated.

To determine the stage of the disease, radiation research methods (ultrasound, CT or MRI) are used, which allow determining the presence of local and distant metastases.

Differential diagnosis

With subungual melanoma, it is often necessary to carry out differential diagnosis with such pathologies as:

• panaritium – purulent inflammation of the tissues of the finger;
• warts – benign neoplasms caused by human papillomaviruses;
• onychomycosis – fungal infection of the nails;
• nevus – a benign neoplasm of pigment cells;
• subepidermal hematoma;
• subungual hematoma;
• Hemangioma is a benign neoplasm of dilated blood vessels.

Treatment of subungual melanoma

The main point in the treatment of subungual melanoma is radical surgery. Its scope is still a matter of controversy. Previously, it was believed that the higher the resection, the lower the likelihood of recurrence and metastases. Therefore, disarticulation of the entire finger was performed. However, studies have shown no statistically significant difference in survival in patients with subungual melanomas who underwent disarticulation compared with those who underwent resection at the level of the middle phalanx of the finger. Therefore, the last option of intervention is currently accepted. This does not worsen the patient’s prognosis and preserves the quality of his life as much as possible.

Radiation therapy

Radiation therapy in the treatment of subungual melanoma is used to irradiate tumor recurrence in the area of ​​the postoperative scar. The second application is the impact on the area of ​​primary lymph nodes to prevent the spread of lymphogenous metastases.

Chemotherapy

Chemotherapy for subungual melanoma can be used in two ways – systemic and regional. At the same time, different protocols may imply adjuvant and neoadjuvant regimens.

Neoadjuvant chemotherapy involves treatment before surgery. This allows you to reduce the size of the tumor and create conditions for its surgical removal.

Adjuvant regimens are prescribed in the postoperative period, and their goal is to destroy the remaining malignant cells, reduce the risk of recurrence and metastasis. As part of chemotherapy, regimens containing dacarbazine, lomustine, tamoxifen, etc. are used. Unfortunately, the effect can only be achieved in 15-20% of patients.

Other therapies

Great promise in the treatment of subungual melanoma lies with immunotherapy and gene therapy. For example, it has been shown that the administration of interferon, interleukin-2, or granulocyte-macrophage colony-stimulating growth factor has a positive effect on the treatment prognosis – overall survival increases, the relapse-free period is extended.

Suppression of p53 and p16INK4a is proposed as a gene therapy for melanomas. These genes activate pathological signaling pathways, through which the cell acquires the ability to divide uncontrollably and invasively grow into underlying tissues.

Complications

Subungual melanoma is characterized by an aggressive course. This is one of the most aggressive forms of this disease. Radical surgery for an invasive tumor does not guarantee a complete cure and prevention of recurrence or the development of metastases. Most often, metastases are found in the lungs and liver, and in terms of the degree of malignancy, they surpass the primary tumor. As the process develops, general complications characteristic of malignant neoplasms join: weakness, anemia, cachexia, etc.

It must be taken into account that the surgical removal of the primary focus of melanoma leads to a partial loss of function of the affected limb. During surgery, a visible defect is formed on the arm, which is almost impossible to hide from others, plus the functionality of the hand is impaired.

In some cases, surgery on the foot requires resection of the metatarsus. This greatly reduces the support of the operated leg and creates an additional load on other parts of the musculoskeletal system, leading to the development of arthrosis, myositis, muscle spasms and other disorders.