What are the common types of nail abnormalities. How do nail abnormalities reflect overall health. Can nail changes indicate underlying medical conditions. What causes changes in nail appearance and texture. How to identify different nail disorders. Are brittle nails a sign of aging or disease. Can nutritional deficiencies affect nail health.

Understanding Nail Abnormalities: A Window into Your Health

Nail abnormalities are more than just cosmetic concerns; they can be valuable indicators of your overall health. These changes in color, shape, texture, or thickness of fingernails or toenails often serve as silent messengers, providing clues about various underlying conditions or nutritional deficiencies.

Recognizing and understanding these abnormalities can be crucial for early detection of health issues. From common problems like fungal infections to more serious systemic diseases, your nails may be trying to tell you something important about your body’s well-being.

Common Types of Nail Abnormalities and Their Significance

Nails can exhibit a wide range of abnormalities, each potentially signifying different health concerns. Here are some of the most common types:

• Beau’s lines: Horizontal depressions across the nails
• Pitting: Small depressions on the nail surface
• Koilonychia: Spoon-shaped nails
• Onycholysis: Separation of the nail from the nail bed
• Leukonychia: White spots or streaks on the nails
• Clubbing: Enlarged fingertips with curved nails

Do these abnormalities always indicate a serious health problem? Not necessarily. While some nail changes can be signs of underlying conditions, others may be harmless or simply a result of aging or minor injuries.

Beau’s Lines: Horizontal Depressions Across Nails

Beau’s lines are horizontal depressions that run across the nails. They can appear when nail growth is interrupted temporarily due to various factors. What causes these distinctive lines? Some common triggers include:

• Severe illness or high fever
• Injury to the nail or surrounding area
• Eczema around the nail
• Chemotherapy treatment
• Nutritional deficiencies

These lines essentially act as a timestamp, marking periods of physiological stress or disruption in your body. The position of the line can even give an indication of when the triggering event occurred, as nails grow at a relatively consistent rate.

Pitting: Small Depressions on the Nail Surface

Nail pitting appears as small, pin-prick like depressions on the surface of the nail. This condition is often associated with psoriasis, affecting up to 50% of people with this skin condition. However, pitting can also be seen in other conditions such as alopecia areata, a type of hair loss.

In some cases, the nail may become loose, crumbly, or even fall off entirely. When should you be concerned about nail pitting? If you notice persistent pitting, especially in conjunction with skin changes or hair loss, it’s advisable to consult a dermatologist for a proper evaluation.

The Link Between Nail Health and Systemic Diseases

Your nails can often reflect the state of your overall health, acting as a barometer for various systemic diseases. Changes in nail appearance or texture may be early warning signs of conditions affecting other parts of your body.

Koilonychia: Spoon-Shaped Nails and Iron Deficiency

Koilonychia, characterized by thin nails that curve inward like a spoon, is often associated with iron deficiency anemia. In this condition, the nails become concave and may even be able to hold a drop of liquid.

Why does iron deficiency cause this distinctive nail shape? Iron is crucial for the production of keratin, a protein that forms the structure of nails. When iron levels are low, nail formation can be disrupted, leading to this characteristic spoon shape.

Yellow Nail Syndrome: A Sign of Respiratory Issues

Yellow nail syndrome is a rare condition characterized by yellow, thickened nails that grow slowly and may detach from the nail bed. This syndrome is often associated with respiratory problems and lymphedema (swelling due to fluid retention).

What causes this striking nail discoloration? The exact mechanism isn’t fully understood, but it’s believed to be related to impaired lymphatic drainage. This condition serves as a visual reminder of the interconnectedness of our body systems, with changes in the nails reflecting issues in the respiratory and lymphatic systems.

Nutritional Deficiencies and Their Impact on Nail Health

Your nails require a variety of nutrients to grow strong and healthy. Nutritional deficiencies can manifest in various nail abnormalities, serving as visible indicators of your body’s nutritional status.

Brittle Nails: More Than Just a Cosmetic Issue

Brittle nails that easily split, peel, or break are a common complaint, especially among older adults. While often attributed to aging, brittle nails can also be a sign of nutritional deficiencies or certain health conditions.

What nutrients are crucial for nail health? Some key players include:

• Biotin (Vitamin B7): Essential for keratin production
• Iron: Necessary for nail strength and growth
• Zinc: Important for nail matrix formation
• Protein: The building block of nails

Can improving your diet help strengthen brittle nails? In many cases, yes. Ensuring adequate intake of these nutrients through a balanced diet or supplements (under medical supervision) can often improve nail health. However, if brittle nails persist despite nutritional improvements, it’s worth consulting a healthcare provider to rule out underlying conditions like thyroid disorders.

White Spots on Nails: Decoding Leukonychia

White spots or streaks on nails, known as leukonychia, are a common nail abnormality that can have various causes. Contrary to popular belief, these spots are not always indicative of calcium deficiency.

What are some potential causes of leukonychia?

• Minor trauma to the nail
• Fungal infections
• Allergic reactions
• Certain medications
• Systemic illnesses in some cases

In most instances, white spots on nails are harmless and will grow out over time. However, if the spots are persistent, widespread, or accompanied by other symptoms, it’s advisable to seek medical evaluation.

Nail Infections: Bacterial and Fungal Culprits

Infections of the nail and surrounding tissues can lead to various abnormalities in nail appearance and texture. These infections can be caused by bacteria, fungi, or viruses, each presenting with distinct characteristics.

Paronychia: Infection of the Nail Fold

Paronychia is an infection of the skin around the nail, often causing redness, swelling, and sometimes pus formation. This condition can be acute (short-term) or chronic (long-lasting), with different causative organisms for each type.

What causes paronychia? Acute paronychia is typically caused by bacteria, often entering through small cuts or injuries around the nail. Chronic paronychia, on the other hand, is often associated with repeated exposure to moisture and can involve both bacterial and fungal pathogens.

How can paronychia be prevented? Some preventive measures include:

• Avoiding trauma to the nails and surrounding skin
• Keeping hands dry and clean
• Using protective gloves when working with water or chemicals
• Avoiding nail biting and cuticle picking

Onychomycosis: Fungal Nail Infections

Onychomycosis, or fungal nail infection, is a common condition that can cause nails to become discolored, thickened, and brittle. These infections are more common in toenails than fingernails and can be challenging to treat.

What are the risk factors for developing onychomycosis?

• Advanced age
• Compromised immune system
• Poor circulation
• Excessive sweating
• Prolonged exposure to moist environments

Treatment for onychomycosis often involves antifungal medications, either topical or oral, and may require several months to effectively clear the infection. In some cases, complete nail removal may be necessary for severe or resistant infections.

Environmental Factors and Nail Health

Your nails are constantly exposed to environmental factors that can affect their health and appearance. Understanding these influences can help you take better care of your nails and prevent unnecessary damage.

The Impact of Moisture and Nail Polish on Nail Health

Excessive exposure to moisture can weaken nails, making them soft and prone to peeling. Similarly, long-term use of nail polish, especially without proper breaks, can lead to nail discoloration and brittleness.

How can you protect your nails from these environmental factors?

• Wear gloves when doing dishes or cleaning
• Dry hands thoroughly after washing
• Take regular breaks from nail polish
• Use a base coat to prevent nail staining
• Moisturize nails and cuticles regularly

By implementing these simple practices, you can significantly improve the health and appearance of your nails, reducing the risk of environmental damage.

Occupational Hazards and Nail Abnormalities

Certain occupations can pose risks to nail health due to exposure to chemicals, frequent hand washing, or physical trauma. For example, healthcare workers, mechanics, and hairdressers may be more prone to developing nail abnormalities.

What precautions can be taken in high-risk occupations?

• Use appropriate protective equipment like gloves
• Follow proper hand hygiene protocols
• Use gentle, fragrance-free soaps and moisturizers
• Report any persistent nail changes to a healthcare provider

By being aware of occupational risks and taking appropriate precautions, you can help maintain healthy nails despite challenging work environments.

When to Seek Medical Attention for Nail Abnormalities

While many nail abnormalities are harmless or easily treatable, some changes may warrant medical attention. Knowing when to consult a healthcare provider can help ensure timely diagnosis and treatment of potentially serious conditions.

When should you be concerned about nail changes? Consider seeking medical advice if you notice:

• Sudden changes in nail color or shape
• Persistent pain or swelling around the nails
• Nails that separate from the nail bed
• Thickening or distortion of the entire nail
• Dark streaks under the nail
• Failure of nail abnormalities to resolve over time

Remember, early detection and treatment of nail disorders can prevent complications and improve outcomes. Don’t hesitate to consult a dermatologist or your primary care physician if you’re concerned about changes in your nails.

Nail Abnormalities as Markers of Systemic Disease

In some cases, nail abnormalities can be the first sign of an underlying systemic disease. For example, clubbing of the nails (enlarged fingertips with curved nails) can be associated with lung diseases, heart diseases, or inflammatory bowel conditions.

What other systemic conditions can manifest as nail changes?

• Diabetes: Can cause yellowing of nails or slow healing of nail injuries
• Psoriasis: Often causes pitting and separation of the nail from the nail bed
• Lichen planus: Can cause thinning and ridging of nails
• Kidney disease: May lead to half-and-half nails (proximal half white, distal half red-brown)

If you have a known systemic condition and notice changes in your nails, it’s important to discuss these changes with your healthcare provider. They may provide valuable information about disease progression or treatment efficacy.

Promoting Healthy Nails: Prevention and Care Strategies

Maintaining healthy nails involves more than just regular manicures. By adopting good nail care habits and addressing underlying health issues, you can promote strong, healthy nails and potentially prevent many common nail abnormalities.

Nutrition for Nail Health

A balanced diet rich in essential nutrients is crucial for maintaining healthy nails. What nutrients are particularly important for nail health?

• Protein: The building block of nails
• Biotin: Helps strengthen brittle nails
• Iron: Essential for nail growth and strength
• Zinc: Important for nail matrix formation
• Omega-3 fatty acids: Help maintain nail moisture

Incorporating a variety of nutrient-rich foods into your diet can help ensure your nails receive the necessary building blocks for optimal health. Consider including lean proteins, nuts, seeds, whole grains, and a rainbow of fruits and vegetables in your meals.

Proper Nail Hygiene and Care

Good nail hygiene practices can go a long way in preventing infections and maintaining healthy nails. What are some key tips for proper nail care?

• Keep nails clean and dry
• Trim nails regularly and file in one direction
• Avoid biting nails or picking at cuticles
• Moisturize nails and cuticles daily
• Use gentle nail care products
• Avoid using nails as tools (e.g., for opening cans)

By implementing these simple practices, you can help protect your nails from damage and reduce the risk of developing nail abnormalities. Remember, healthy nails are not just about appearance – they’re an important aspect of your overall health and well-being.

Understanding nail abnormalities and their potential implications can provide valuable insights into your overall health. By paying attention to changes in your nails and seeking appropriate medical attention when needed, you can use this often-overlooked aspect of your body as a tool for monitoring your well-being. Remember, healthy nails are more than just a cosmetic concern – they’re a reflection of your body’s internal health and a window into potential underlying conditions.

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.