When Peggy Waters’ thumbnail split open, she didn’t think much of it. “I just put a Band-Aid down around it to pull the two sides together, but I didn't really think anything about it,” she says.
Fast forward a year and a half and she was being treated for melanoma under her nail.
It’s rare, but it happens.
Dr. Phoebe Rich explains, “about one percent of all melanomas occur under and around the nail, and it varies a bit by ethnicity. So the darker your skin, the fewer melanomas you have in general, but the more likely they are to occur under and around the nail.”
Dr. Rich says nail melanomas are generally painless, which is a problem because people aren’t aware anything is happening.
There are signs to look for, though. She says, “The most common sign is a pigmented stripe in the nail. It starts as a brown or black or even gray band in the nail that starts at the cuticle and runs out to the free edge of the nail.”
Or, the nail may split—like Peggy’s did. By then, the melanoma may have spread.
What are the risk factors?
Dr. Rich says, “UV light and sunburn plays a very little role. What's more important is family history. They generally occur in people over age 50, although we see them in all age groups.” A history of nail trauma is also a factor. The most common digits to get it are the thumb and big toenail.
“If you diagnose them early and get them off early, there's a very very good chance of cure. But if you let them go and they remain undetected and undiagnosed, they're almost always fatal,” Dr. Rich explains.
Treatment may include removing the nail or, in extreme cases, taking off the finger or toe tip.
They can be diagnosed during an exam with magnification and special polarized light, and in some cases, a biopsy.
Peggy says she’ll never wait again if she sees an issue with her nails, explaining, “If I see something strange that's happening on my skin, I get it checked immediately.”
It’s important to have regular examinations with a dermatologist and point out any changes in your nails.