![A doctor inspecting a person's toenail for cancer signs](https://images.medicinenet.com/images/article/main_image/what-does-a-cancerous-toenail-look-like.jpg?output-quality=75)
A cancerous toenail, also called toenail melanoma or subungual melanoma, is a subtype of malignant melanoma of the skin, but one which originates in structures within the nail.
Subungual melanomas are rare and make up just 0.7% to 3.5% of all malignant melanomas worldwide. About 75% to 90% of reported cases of subungual melanoma occur in the big toe or thumb.
7 Symptoms of Cancer of the Toenail
A cancerous toenail may look like:
- Brown-black discolorations of the nail bed
- Can look like a dark, narrow band in the nail
- May look like a wide and irregular area of pigmentation
- Dark skin next to the nail
- Nail thickening
- Splitting nails
- Nail separating from the nail bed
- The white top edge of the nail will look longer as the nail lifts
- Bump or nodule under the nail
- Destruction of the nail with pain and inflammation
How Is a Cancerous Toenail Diagnosed?
A cancerous toenail (subungual melanoma) is diagnosed with a patient history and a physical examination of the toenail.
Doctors often used “ABCDEF guidelines” to assess the risk of a pigmented nail lesion being a melanoma:
- Age: 50 to 70 years, and African, Japanese, Chinese, and Native American heritage
- Brown-black band greater than 3mm with an irregular border
- Change in size and growth rate
- Digit: big toe, thumb, or index finger
- Extension of discoloration into the skin surrounding the nail (Hutchinson sign)
- Family histology of melanoma
If melanoma is suspected, a full-thickness biopsy of the nail bed is taken to confirm a diagnosis.
A lymph node biopsy may be performed to determine if the cancer has spread to lymph nodes.
What Is the Treatment for a Cancerous Toenail?
Treatment for a cancerous toenail (subungual melanoma) usually involves removal of the lesion (excision). The cancer must be removed with wide margins, which involves removal of the tumor and a wide margin of healthy surrounding tissue.
If the cancer has spread to lymph nodes, lymph nodes may be removed.
Other treatments for cancerous toenail may include:
- Radiation
- Only used in specific circumstances
- Reserved for use on the lymph nodes or brain metastases
- Immunotherapy
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https://www.ncbi.nlm.nih.gov/books/NBK482480/
https://www.aad.org/public/diseases/skin-cancer/types/common/melanoma/nail-melanoma