By Steve Blanchard - April 22, 2022
When Maria Sylvia saw a strange, discolored streak on her right thumbnail, she wasn’t sure what to think. But after consulting some friends and eventually an oncologist, she learned that it was a rare form of melanoma called subungual melanoma that forms in the finger or toe nailbeds.
Dr. James Grichnik, a dermatologist at Moffitt Cancer Center and chair of the University of South Florida’s Department of Dermatology and Cutaneous Surgery, said it is a subtype of melanoma that is not necessarily linked to ultraviolet light radiation.
“This is somewhat distinct from the melanoma types associated with sunburns or chronic sun exposure,” Grichnik said. “Genetically these are often different, and a fair proportion do not reveal strong UV signatures.”
It’s unclear exactly what drives this type of melanoma, but Grichnik said it also occurs in patients with medium and darker skin tones.
“All races and genders can get this type of melanoma,” Grichnik said.
@invrfoundwaldo Reply to @alec558 ♬ original sound - Maria
For Sylvia, it took her years to get a diagnosis. Several visits to doctors and dermatologists led to inconclusive results or assumptions that the discoloration was a blister or a mole. It was a friend who found an article about subungual melanoma that convinced Sylvia to seek out a biopsy. When Sylvia insisted on a biopsy, she finally had her diagnosis.
“Often in order to get a biopsy, the nail needs to be removed,” Grichnik said. “We tend to treat this type of melanoma in a similar manner to other melanomas – we excise it with margin of skin. However, for some of these tumors if large and deeply invasive, an amputation of the fingertip or toe maybe required.”
Fortunately for Sylvia, amputation was not necessary. However, she will need physical therapy on her right hand to learn how to move her thumb properly again and she will never regrow her thumbnail because of the surgery.
As with most forms of skin cancer, subungual melanoma is more easily treated when discovered early. Grichnik recommends paying attention to your skin and your nails and monitoring any changes.
“If you have a new growing or changing pigment streak in a nail, it is worth taking a look at,” he said. “Some people do have normal pigmented nail bands, often in more pigmented skin types, but if a nail bed is unique or doesn’t match others, get it checked out, especially if the pigmentation wraps around the nail and is impacting the skin.”
"Some people do have normal pigmented nail bands, often in more pigmented skin types, but if a nail bed is unique or doesn’t match others, get it checked out, especially if the pigmentation wraps around the nail and is impacting the skin."- Dr. James Grichnik, Moffitt dermatologist
Grichnik adds that this type of melanoma also impacts the palms of your hands, the soles of your feet and even your lips and other mucosal surfaces.
“There are a number of treatments depending on when it’s discovered and where it is located,” Grichnik said. “Many melanomas are treatable and can be potentially cured, but subungual melanomas can be more challenging to treat, which is why early detection is so important.”
Sylvia hopes that sharing her journey on social media will raise awareness about this particular type of melanoma and said that many have already reached out to her thanking her for prompting them to get their discolored nails checked.
“Sometimes oversharing on the internet can be beneficial,” Sylvia said on TikTok.