What are the common types of nail abnormalities. How can nail changes indicate underlying health issues. What causes nail abnormalities and how are they treated. When should you see a doctor for nail problems.

Common Types of Nail Abnormalities

Nail abnormalities encompass a wide range of conditions affecting the color, shape, texture, or thickness of fingernails and toenails. Understanding these abnormalities can provide valuable insights into one’s overall health. Here are some of the most common types:

• Beau’s lines: Horizontal depressions across the nails
• Onycholysis: Separation of the nail from the nail bed
• Leukonychia: White spots or streaks on the nails
• Koilonychia: Spoon-shaped nails
• Pitting: Small depressions on the nail surface
• Ridges: Vertical or horizontal lines on the nails
• Paronychia: Infection of the skin around the nail

Each of these abnormalities can have different causes and may indicate various underlying health conditions. For instance, Beau’s lines often appear after an illness, injury, or during chemotherapy. Koilonychia is frequently associated with iron deficiency anemia, while pitting is commonly seen in individuals with psoriasis or alopecia areata.

The Link Between Nail Health and Overall Wellness

Our nails can serve as a window into our body’s internal health. Changes in nail appearance or texture often reflect nutritional deficiencies, systemic diseases, or localized infections. For example:

• Pale nails may indicate anemia
• Yellowing of nails could suggest liver problems or diabetes
• Clubbing of nails might be associated with lung or heart diseases
• Brittle nails often result from aging but can also indicate thyroid issues or nutritional deficiencies

Can nail abnormalities always indicate a serious health problem? Not necessarily. While some changes can be concerning, many nail abnormalities are benign or result from minor injuries or environmental factors. However, persistent or severe changes should be evaluated by a healthcare professional to rule out underlying conditions.

Causes of Nail Abnormalities

Nail abnormalities can arise from various factors, ranging from external injuries to internal health issues. Understanding these causes can help in prevention and appropriate treatment. Here are some common causes:

Injuries and External Factors

• Trauma to the nail or nail bed
• Chronic picking or rubbing of the skin behind the nail
• Prolonged exposure to moisture or harsh chemicals
• Frequent use of nail polish or artificial nails

Infections

• Fungal infections (onychomycosis)
• Bacterial infections
• Viral infections (such as warts)

Systemic Diseases and Nutritional Deficiencies

• Psoriasis
• Lichen planus
• Anemia
• Diabetes
• Thyroid disorders
• Zinc or iron deficiency

Is it possible to prevent nail abnormalities? While some causes are beyond our control, many nail problems can be prevented or minimized through proper nail care, a balanced diet, and protection from trauma and harsh chemicals.

Diagnostic Approaches for Nail Abnormalities

When faced with nail abnormalities, healthcare professionals employ various diagnostic methods to determine the underlying cause. These may include:

1. Visual examination: A thorough inspection of the nails and surrounding skin
2. Medical history review: Gathering information about overall health, recent illnesses, and medications
3. Nail clippings or scrapings: For laboratory analysis, especially in suspected fungal infections
4. Blood tests: To check for systemic diseases or nutritional deficiencies
5. Nail biopsy: In rare cases, to rule out serious conditions like nail melanoma

How long does it typically take to diagnose a nail abnormality? The time frame can vary significantly depending on the condition. While some issues can be diagnosed immediately through visual examination, others may require laboratory tests that can take several days or weeks to yield results.

Treatment Options for Nail Abnormalities

The treatment of nail abnormalities depends on the underlying cause and the specific condition. Here are some common approaches:

Topical Treatments

• Antifungal creams or lacquers for fungal infections
• Antibacterial ointments for bacterial infections
• Corticosteroid creams for inflammatory conditions

Oral Medications

• Antifungal pills for severe fungal infections
• Antibiotics for bacterial infections
• Nutritional supplements for deficiencies

Lifestyle and Home Remedies

• Proper nail hygiene and care
• Avoiding harsh chemicals and excessive moisture
• Wearing protective gloves during household chores
• Maintaining a balanced diet rich in essential nutrients

Do all nail abnormalities require medical treatment? Not always. Many minor nail issues can be managed with proper care at home. However, persistent or severe problems should be evaluated by a healthcare professional to determine the best course of action.

Prevention Strategies for Healthy Nails

Maintaining healthy nails is an important aspect of overall health and well-being. Here are some strategies to prevent nail abnormalities:

• Keep nails clean and dry to prevent fungal growth
• Trim nails regularly and file them in one direction to prevent splitting
• Avoid biting nails or picking at the cuticles
• Use moisturizer on nails and cuticles to prevent dryness and cracking
• Wear gloves when working with water or chemicals
• Eat a balanced diet rich in protein, biotin, and essential minerals
• Avoid using harsh nail products or wearing artificial nails for extended periods

Can nail supplements improve nail health? While some supplements claim to promote nail health, their effectiveness varies. A balanced diet usually provides all the necessary nutrients for healthy nails. However, individuals with specific deficiencies may benefit from targeted supplementation under medical supervision.

When to Seek Medical Attention for Nail Problems

While many nail abnormalities are harmless, certain signs warrant professional medical evaluation. Consider seeking medical attention if you notice:

• Persistent changes in nail color, shape, or texture
• Signs of infection, such as redness, swelling, or pus
• Severe pain or discomfort around the nails
• Nails that separate from the nail bed
• Dark streaks or spots under the nails
• Nail changes accompanied by other systemic symptoms

Should you see a dermatologist or a general practitioner for nail problems? For most nail issues, starting with your primary care physician is appropriate. They can provide initial assessment and treatment or refer you to a dermatologist if specialized care is needed. Dermatologists have extensive training in diagnosing and treating nail disorders and can offer advanced treatments when necessary.

The Impact of Lifestyle on Nail Health

Our daily habits and lifestyle choices can significantly influence the health and appearance of our nails. Here’s how various factors can affect nail condition:

Diet and Nutrition

A balanced diet rich in protein, vitamins, and minerals is crucial for nail health. Nutrients particularly important for nails include:

• Biotin (Vitamin B7): Strengthens nails and promotes growth
• Iron: Prevents brittle nails and supports oxygenation of nail cells
• Zinc: Essential for nail growth and repair
• Protein: Forms the building blocks of nails
• Omega-3 fatty acids: Promote nail flexibility and moisture

Hydration

Adequate water intake helps maintain nail moisture and prevents brittleness. Aim for at least 8 glasses of water daily to support overall nail health.

Occupation and Hobbies

Certain jobs or activities can put nails at risk for damage or abnormalities:

• Healthcare workers: Frequent handwashing and glove use can lead to dry, brittle nails
• Construction workers: Increased risk of trauma and exposure to harsh chemicals
• Musicians: String instruments can cause nail deformities
• Swimmers: Prolonged water exposure may lead to softened, brittle nails

Stress and Mental Health

High stress levels can impact nail health in several ways:

• Reduced blood flow to nail beds, affecting growth and appearance
• Increased likelihood of nail-biting or picking
• Potential nutrient deficiencies due to poor eating habits during stressful periods

How quickly can lifestyle changes improve nail health? While it varies among individuals, noticeable improvements in nail strength and appearance can often be seen within 3-6 months of implementing positive lifestyle changes. However, complete nail renewal can take up to 6 months for fingernails and up to 18 months for toenails.

Myths and Facts About Nail Health

There are many misconceptions surrounding nail health and care. Let’s separate fact from fiction:

Myth: White spots on nails indicate calcium deficiency

Fact: White spots, known as leukonychia, are usually caused by minor trauma to the nail and rarely indicate nutritional deficiencies.

Myth: Gelatin supplements strengthen nails

Fact: While gelatin contains proteins found in nails, there’s limited scientific evidence supporting its effectiveness in strengthening nails when taken as a supplement.

Myth: Nails need to “breathe” between polish applications

Fact: Nails don’t actually breathe. However, taking breaks from nail polish can prevent discoloration and allow you to monitor nail health.

Myth: Applying vitamin E directly to nails promotes health

Fact: While vitamin E is beneficial when consumed in the diet, there’s little evidence that topical application significantly improves nail health.

Myth: Manicures are purely cosmetic and don’t affect nail health

Fact: Professional manicures can actually promote nail health by keeping nails clean, properly shaped, and moisturized. However, aggressive techniques or overuse of harsh chemicals can be damaging.

Are natural remedies effective for treating nail abnormalities? Some natural remedies, such as tea tree oil for fungal infections or olive oil for moisturizing, may have benefits. However, their effectiveness can vary, and they should not replace professional medical advice for persistent or severe nail problems.

The Future of Nail Health: Emerging Research and Treatments

The field of nail health is continuously evolving, with new research shedding light on nail biology and potential treatments. Here are some exciting developments:

Advanced Diagnostic Tools

• Dermoscopy: High-resolution imaging for early detection of nail disorders
• Optical coherence tomography: Non-invasive imaging technique for detailed nail structure analysis
• AI-powered nail health apps: Utilizing machine learning for at-home nail assessments

Innovative Treatments

• Photodynamic therapy: Using light-activated compounds to treat fungal infections
• Nanotechnology-based treatments: Enhancing drug delivery for nail disorders
• Stem cell therapy: Potential applications for nail regeneration

Personalized Nail Care

• Genetic testing for predisposition to nail disorders
• Customized nutritional plans based on individual nail health needs
• 3D-printed nail prosthetics for severe nail loss or deformities

How might these advancements change the way we approach nail health in the future? As technology progresses, we can expect more precise diagnoses, targeted treatments, and personalized prevention strategies. This could lead to earlier detection of nail abnormalities, more effective treatments, and improved overall nail health for individuals across all age groups.

In conclusion, nail abnormalities can range from minor cosmetic issues to indicators of significant health problems. By understanding the various types, causes, and treatments of nail abnormalities, individuals can take proactive steps to maintain healthy nails and seek appropriate care when needed. Regular nail care, a balanced diet, and attention to overall health can go a long way in preventing many common nail issues. As research in this field continues to advance, we can look forward to even more effective ways of diagnosing, treating, and preventing nail abnormalities in the future.

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.