Subungual melanoma, also known as acral lentiginous melanoma, is a type of skin cancer that occurs underneath the fingernails or toenails. Due to its inconspicuous location, the cancer is often difficult to diagnose, with the discovery of its presence often occurring after it has reached an advanced stage. Treatment is typically relegated to surgery, though chemotherapy may be used for more-advanced cases.
Subungual melanoma is very rare, and is most commonly found in African-Americans and Asians. It accounts for approximately 5 per cent of all melanoma cases, and typically occurs on the thumb or big toe. The median age of people affected by the cancer is between 60 and 70 years old.
Symptoms of subungual melanoma are typically hard to find due to their presence in a relatively overlooked location. Subungual melanomas often appear as a dark line underneath the nail; however, given the predisposition of the condition to occur in darker-skinned individuals, such lines under the nails are often common and benign. In the event that the streak changes shape or colour, or if a new streak appears, consult your doctor immediately. Other indications of advanced subungual melanoma include a damaged nail bed or hyperpigmentation of the skin.
Treatment for subungual melanoma typically involves surgery that depends on the stage and severity of the centre. If the melanoma has not progressed beyond a depth of 1mm, wide local excision is all that is necessary. However, if it has gone beyond a depth of 1mm, excision with the addition of a lymph-node biopsy is recommended. In the event that the melanoma has become too advanced, complete surgical removal of the affected toe or finger may be necessary.
In some cases where surgery isn't entirely effective, chemotherapy may be used. Chemotherapy involves cancer-killing drugs that attack and destroy cancer cells.