How to recognize subungual melanoma and why it appears. Subungual melanoma

Previously, nail melanoma was diagnosed mainly in older people. Today the disease has become younger. The true causes of the development of pathology are unknown to scientists. Suggestions have been made about factors that may increase the chance of tumor formation.

Possible causes of nail melanoma:

• Trauma - patients suffered serious damage to the nail, and timely treatment with antiseptic agents was not carried out.
• Ultraviolet irradiation - neoplasms often appear at the site of burns. Excessive passion for sunbathing and solariums can provoke an oncological process on the nail.
• Heredity - in families whose representatives have been diagnosed with nail melanoma, the disease is much more common.

The risk factors are complemented by a person's lifestyle. With a lack of sleep, an unbalanced diet, and lack of physical activity, the body weakens. It is unable to resist many diseases, including cancer. Nail melanoma often occurs in people with weakened immune systems.

The risk group includes all people over 50 years of age. They need to monitor changes in the body more carefully.

In terms of growth rate, this pathology is surpassed only by lung cancer. Previously, it tended to manifest itself in patients of the elderly age category, but nowadays it is noticed in young people more often, compared to previous generations.

Among oncological diseases, subungual melanoma accounts for 3% of cases in women and 4% in men, and although science is not able to say the reliable reasons for its development.

The causes of subungual melanoma are not fully understood to date. The only thing that scientists have been able to confirm is that melanoma often appears as a consequence of injury. Well, sometimes melanoma forms at the site of a mole.

The reason for the development of this neoplasm is unknown. Despite studies conducted in different countries of the world, the etiology of any melanoma cannot be identified. It is known that there are phenotypic characteristics, living conditions and pathological conditions that predispose to the formation of this tumor. These risk factors include:

• Frequent exposure to direct ultraviolet rays. There is a theory that ultraviolet radiation promotes the proliferation of pigment cells and their malignant degeneration. Those who work outdoors during the day and people who frequently visit solariums are at particular risk.
• Low amount of melanin. People with blue eyes, blond or red hair, white skin and freckles are at greater risk.
• History of sunburn. They can be a trigger in the process of neoplasm development. The reason for this is not clear.
• History of melanomas of other localization.
• Nevi of periungual localization.

How to distinguish subungual melanoma from everything else?

Here is a fairly simple algorithm.

ABCDEF rule for diagnosing nail bed melanoma

And (age) age - the peak incidence of subungual melanoma occurs between the ages of 50 and 70 years, and also denotes races with an increased risk: Asians, Africans - they account for 1/3 of all melanoma cases.

B (brown to black) – the color is brown and black, with a stripe width of more than 3 mm and blurry boundaries.

C (change) – change in the color of the nail plate or no change after treatment. D (digit) – finger as the most common site of injury.

E (extension) - spread of pigmentation to the nail fold or fingertip (Hutchinson's symptom).

Kinds

Of the total number of melanomas, the share of this tumor is only 2%, i.e. in absolute values ​​in 170 people per year. Against the background of the country's total population of 146,000,000, this, in my opinion, is very small. At the same time, a low incidence rate does not eliminate the possibility of getting sick.

For representatives of other skin phototypes other than 2, the chances may be very different. Representatives of the Mongoloid and Negroid races have a higher (up to 40%) chance of developing melanoma of the nail bed.

Where does subungual melanoma appear most often?

The tumor most often affects the big toes.

Oncology can affect a separate area of ​​the nail. Depending on the location of the pathology, there are the following types of acral-lentiginous melanoma:

• from the nail matrix - the formation is formed in the area of ​​the nail bed, gradually spreading to the entire area;
• from under the nail plate - a neoplasm appears on any area of ​​the skin under the nail, over the course of several months it grows;
• from the skin located nearby - the oncological process begins on the skin next to the plate, gradually moving to one of its sides.

Patients often turn to specialists in later stages. This is due to the fact that many see the tumor as a normal injury to a finger with a plate. Some patients actually had a nail bruise shortly before the onset of pathology.

There are several types of subungual melanoma:

• developed from the nail matrix (a section of skin located under the root of the nail, responsible for the production of new tissue);
• emerging from under the nail plate (the main part of the nail that protects the soft tissue of the finger);
• evolved from the skin located next to the nail plate.

Stages

Nail melanoma is constantly evolving. In some cases this happens slowly, in others it happens quickly. Based on the change in behavior of the disease, the following stages of its development are distinguished:

• Stage 1 – the thickness of the neoplasm is no more than 1 mm, it does not bother the person.
• Stage 2 – the tumor takes root, but not more than 2 mm. It changes color, spreads across the plate, and becomes more noticeable.
• Stage 3 – the primary focus spreads its particles. As a rule, the nearby lymph nodes are the first to be affected. This is the beginning of the metastasis process.
• Stage 4 – secondary tumors develop in various human organs and tissues.

The pathology responds well to treatment in the early stages, before metastasis. Therefore, it is important to recognize it in time.

T – tumor. Indicates the local prevalence of the process.

• T1 – sizes up to 1 mm;
• T2 - 1-2mm;
• T3 - 2-4mm;
• T4 - more than 4mm.

A form of cancer with a rapid, severe course, nail melanoma is rare. At the moment there are no means to successfully fight the disease if it has begun to metastasize. Starting treatment at stages I and II can stop development.

Warming melanoma is treated in the first two stages

At-risk groups

The diagnosis of subungual melanoma is made in most cases to people predisposed to the disease. Risk factors are observed in groups:

• with hereditary characteristics;
• fair-haired, pale-skinned from birth;
• after sunburn;
• fans of solariums;
• age representatives of the male and female half.

“At forty years old we are faced with a choice: either to extend our Youth, or to extend our Life...” - Jacques Deval.

Those who fall into one of the categories should carefully examine their fingers. If symptoms are detected, even if there is doubt, subungual melanoma is excluded by the results of the examination.

Symptoms of the disease

Melanoma on the nails has its own signs that make it possible to distinguish it from other diseases. As the disease progresses, symptoms may change. An inconspicuous defect becomes a noticeable tumor. Specific changes and signs:

• first, a small pigment spot or stripe on the nail plate appears under the nail;
• the defect does not go away after 2 weeks, like a hematoma after a bruise;
• there is a gradual increase in pigment;
• color changes, turning into dark brown, black;
• the edges become uneven;
• the damage extends to the nail fold;
• cracks, nodules, and wounds with bleeding are formed;
• the nail plate becomes deformed, bending and thickening.

Subungual melanoma does not always darken. The disease develops over a long period of time without suspicion of its severity. If there are changes in the nail area, you should monitor their progress. Symptoms become apparent at stage III, when metastases are already developing.

With melanoma, the color and shape of the nail changes

Reasons for appearance

Any neoplasm has a cause that affects its activation. The target is the nail. The basis for its origin is considered to be:

• living in a poor ecological climate;
• consumption of modified, low-quality products;
• relationship with harmful carcinogenic substances;
• bad habits (often cheap alcoholic drinks, tobacco);
• nail injuries;
• signs of one of the risk groups.

A healthy cell, according to the conclusions of modern scientists, mutates, changing the number of genes, and is rebuilt with a violation of its usual integrity. Changes in DNA, enzymes, and genes provoke factors that cause the occurrence of nail melanoma.

Types of nail melanoma

Melanonychia longitudinal develops from a strip on the nail plate. Occurs in representatives of the dark-skinned race. Most often these are African Americans (more than 75%), Japanese (about 15%). Other peoples with dark skin. White Europeans almost never get this type of melanoma (1%).

Externally, melanonychia is a pigmented stripe located longitudinally along the nail plate. More than one nail may be damaged. Development is determined by a high level of melanin in the plate. Detected by examining the profile of the distal nail edge.

Often, longitudinal melanonychia appears after a chronic injury to the big toe. Benign tumors do not require treatment. If it becomes cancerous, amputation of the toe joint is recommended.

– forms on the nail bed. It is distinguished by a black color similar to the consequences of a bruise. The neoplasm cannot be palpated until it acquires the size of a malignant vertical tumor. Soreness, increased pigment, longitudinal splitting of the nail plate, changes in shade - reflect the stage of the disease.

The consequence of a nail tumor can be melanoma of the leg. The opposite effect occurs when a rapidly growing tumor on the leg, emerging from an old mole, sends cancerous tentacles to other organs. Additional symptoms for this disease are severe itching, inflammation along the edge of the pigment spot, bleeding of the tumor. It is worth repeating once again that only prompt diagnosis and initiation of treatment can save from death.

Melanoma of the foot is common on the big toes and is determined by histological examination of tissue sampled from the patient. Nodular formations that rise above the skin level are considered to be aggressively developing.

Acral melanoma looks like a bruise

Treatment of nail melanoma

Melanoma on the finger, nail plate, or bed is treated only in the first two stages, until metastases have spread throughout the body.

Therapeutic method includes medications that suppress pain, division, and spread of cancer cells. Chemotherapy and laser irradiation are gentle methods used only at the initial stage of the disease.

Surgical intervention, amputation of one, two phalanges, or a finger is indicated if the metastasis has not spread beyond the boundaries of the oncological focus.

A malignant neoplasm can return, appearing anywhere in the human body if damaged cells enter the lymph or circulatory system. They are not always detected.

When melanoma on the leg is advanced, death is almost guaranteed. Treatment (surgery, course of radiation, chemotherapy) is carried out to relieve excruciating pain and provide the patient with an easy death.

Surgery will eliminate the source of cancer

Prevention of cancer

The main preventive measure is preventive examination. It is necessary to undergo it at least once a year. Early detection of diseases is the main task of any person.

To maintain health, follow these simple recommendations:

• adhere to a nutritional culture: a balanced menu, the absence of genetically modified products in the diet that are oversaturated with chemicals;
• Quit smoking and alcohol abuse. Products of low quality and high levels of carcinogens are especially harmful;
• Protect the purity of intimate relationships. Be selective in sexual relations, maintain hygiene, use protective equipment during sexual intercourse;
• Living in an area with high environmental pollution, go to the sea more often, not necessarily in the summer, and use sanatoriums and health services in resort areas. Do not be in the open sun;
• having a history of hereditary predisposition, examine yourself more carefully and undergo laboratory examination;
• Load your body with physical exercise. Play sports, saturating the body with oxygen, activating the work of all organs, improving blood circulation;
• Strengthen the immune system, the best barrier to viruses and bacteria. The body is a wise and complex apparatus, capable of redistributing forces with a healthy immune system;
• monitor hormonal levels so that a lesion does not form due to pathology of the endocrine system.

Annual statistics record an increase in malignant diseases. It is unrealistic to exclude a sad diagnosis, but everyone can reduce the risk by protecting their body. Now you know what subungual melanoma is and how to treat it.

Sometimes an illness appears in the human body for no tangible reason, which is associated with the uncontrolled self-reproduction of cells. One of the varieties of such ailments is nail melanoma. The initial stage of the disease is not very noticeable and may resemble other destructive processes. Therefore, patients seek help at a later stage.

Features of the disease

In simple terms, nail melanoma is a type of cancerous tumor, which is characterized by aggressive development and a specific clinical picture. If we take all cancer diseases, then about 4 percent are due to this disease.

Medical statistics show that in most cases the thumb on the right hand is affected. The preliminary stage of the oncological process occurs hidden. It is not always possible to detect cancer by external parameters.

Most often, nail melanoma is stained with epithelial pigment. In this case, it becomes much easier to establish the correct diagnosis, even with a preliminary examination by a doctor. About 20 percent of malignant tumors do not have this color, which complicates diagnosis.

Reasons for appearance

Various factors can lead to degeneration of nail plate cells:

• the presence on the skin of benign neoplasms such as moles and other growths that began to form a tumor body;
• congenital epithelial defects with atypical growths present on the patient’s fingers from the very beginning of life;
• the course of an oncological process in any organs or areas of the body, leading to damage to the nail plate by metastases;
• formation of a chancre under the nail plate resulting from a fungal or viral infection;
• regular injury at the site of tumor origin under severe physical conditions;
• exposure of the surface of the fingers to direct sunlight.

The listed risk factors can give the oncological process an initial impetus. As a result, nail melanoma forms. Photos showing its development in later stages can no longer be confused with other diseases. From the appearance of the nail plate it immediately becomes clear that there is a cancerous formation.

Main symptoms

In case of cancer, attention should be paid to a number of important points. Although the disease can easily be confused with a common fungal infection, there are significant signs that help make the diagnosis.

Usually pay attention to the following symptoms of nail melanoma:

1. Tumor formation. Often a dense-looking growth of degenerated cells is formed. It is he who begins to destroy the structure of the nail plate. Pores appear on its surface, after which the layers separate.
2. Change in nail color. In fact, this is one of the most important signs of a pathological process. The surface may turn blue, black, brown or purple. If the surface of the nail has changed color without any noticeable damage, the patient should seek help from a medical facility.
3. The presence of a vertical stripe. As the tumor body grows, a clear vertical line often forms, dividing the surface into two parts. It most often appears in the center of the plate. The strip may change color over time. Everything will depend on the specifics of the course of the cancer.
4. Leakage of pus from under the nail plate. In later stages, severe inflammation begins. A large amount of pus is released. The use of anti-inflammatory drugs and antibiotics in this case does not give the desired effect.
5. Frequent pain at the site of the lesion. When you press on your finger, they become pronounced. During periods of regular exacerbations, pain intensifies even in a calm state. A distinct pulsation is felt in the area of ​​oncology.
6. from the base. As the disease progresses, the plate does not receive the necessary nutrition, so it begins to peel off from the finger. Only a soft cushion, modified by the ongoing oncological process, remains visible.

The presence of two or more signs allows the doctor to assume that the patient has developed melanoma of the toenail or hand. Sometimes mistakes do occur, for example, a specialist examining a patient confuses this ailment with panaritium, which belongs to the category of infectious diseases.

Types of tumors and characteristics

Melanomas can be of different types. The main types of such tumors are shown in the table:

Types of nail plate tumors

Characteristic

Superficial

Acral

Received the greatest distribution. With this development of events, cell changes largely affect the outer skin. Deep layers are affected only in the absence of timely treatment.

In all respects, the tumor is similar to the one mentioned above. It develops, affecting the same layers of skin. Its peculiarity is uneven pigmentation.

It begins to appear on the surface layers of the skin, but gradually grows inside. The nail takes the form of a dark spot. Most often observed in dark-skinned people.

Characterized by deep germination into epithelial tissue. The tumor is characterized by the most aggressive nature of the lesion.

Stages of the disease

In the first two stages, melanoma under the nail has quite limited dimensions. The growing cells do not yet affect deep tissues and internal organs. The risk of spread is not too high.

In total, there are four main stages of the disease, the main evaluation criterion of which is the thickness of the formation:

• At the first stage, the thickness of the formation is less than 1 mm. The surface of the nail has no obvious damage and no ulcers are found. There is no pain when pressed.
• At the second stage, the thickness reaches 2-4 mm. Small ulcerations appear. Often tubercles form directly on the nail plate.
• At the third stage, the thickness of the formation is 4 mm or more. Tumor cells have already reached regional lymph nodes, creating secondary foci there.
• At the fourth stage, it no longer matters how thick the tumor has reached. Metastases spread to various organs. The pain is very strong. The size of the tumor increases significantly.

As for pain, it can appear already in the second stage, when the thickness of the growth begins to reach 2-4 mm. However, this does not always happen. In some cases, pain does not occur until the very last stage, until the bone tissue of the finger begins to be completely affected.

Basic diagnostic options

It is important to accurately determine at the right time that nail melanoma has appeared. The initial phase of the disease is much easier to treat than the later phase. To identify a dangerous disease, special diagnostic measures are used:

• general study of urine and blood tests;
• conducting MRI;
• taking tissue for biopsy;
• transillumination of the nail plate with a special device;
• performing ultrasound examination;
• determining the presence of cancer markers;
• obtaining a puncture from the lymph nodes.

The listed options allow you to obtain certain information, but they are usually carried out in combination. After studying the results, a specific conclusion is made.

Treatment process

Before starting treatment for nail melanoma, the presence of metastases is determined. At the initial stages, the patient has the emerging tumor removed surgically. If necessary, healthy tissues located around the affected area are also affected. The phalanx is cut off only in advanced cases.

When metastases form, the effectiveness of treatment decreases sharply. The patient may additionally be prescribed radiation or chemical therapy. Sometimes lymph nodes must be removed.

Survival prognosis

When assessing the prospects for treatment of nail melanoma, the stage of detection of the disease plays an important role. Even if the patient has recovered, it is necessary to constantly monitor his well-being. There is a high risk of relapse of the disease. Sometimes even after several years the disease returns.

The five-year survival rate in the presence of a tumor as a percentage is expressed as follows:

• At the first stage - 95%.
• At the second stage - 70%.
• At the third stage - 30%.
• At the fourth stage - 7%.

Low survival rate in the last stages is due to the appearance of metastases, which can occur not only in the fingers affected by the disease, but also in other parts of the body.

Final part

To avoid complex and lengthy treatment for nail melanoma, it is necessary to adhere to preventive measures. You should limit your exposure to direct sunlight, and also avoid bad habits such as drinking alcohol and smoking tobacco products. If there are suspicious changes in the nail plate, you should immediately consult a doctor.

Definition. Nevi in ​​the form of longitudinal melanonychia, located along the nail plate.

Age and gender. Nevus occurs at the same age as regular moles. There are no gender differences. Longitudinal melanonychia, caused by a melanocytic nevus or melanotic spot, can sometimes occur after 30 years of age.

Etiology and pathogenesis of nail bed nevus. Longitudinal melanonychia can be caused by the following reasons: increased melanin content in the cells of the basal layer of the epidermis due to excessive activity of melanocytes without increasing their number (melanotic spot and other factors); benign proliferation of melanocytes (lentigo, melanocytic nevus); melanoma growth. Longitudinal melanonychia in children is almost always a melanocytic nevus (borderline or mixed) or melanotic spot.

Clinic. A nevus, as a rule, is located on one finger in the form of a longitudinal brown or black line running along the nail plate, 1-4 mm wide.

Diagnosis of nail bed nevus is established according to clinical and anamnestic data, as well as during dynamic observation of melanocytic nevus of the nail bed. If there is any doubt about the benign nature of a subungual lesion, a biopsy is necessary.

Differential diagnosis of nail bed nevus. When longitudinal melanonychia occurs, it is necessary to carry out a differential diagnosis primarily between melanocytic nevus, lentigo, melanotic spot and subungual melanoma. In children, longitudinal melanonychia is usually represented by a benign pigmented lesion. Subungual melanoma in children is reported extremely rarely in the literature.

It was mainly detected in black children and people living in Asia. However, publications have now appeared on the occurrence of subungual melanoma in situ in fair-skinned children.

Melanocytic nevus of the nail bed of the first toe in the involution stage in a 54-year-old patient.
At the age of 11-12 years, a longitudinal pigment stripe appeared.
At the age of 35-40, it became discolored, but splitting of the nail plate occurred.

A. Tosti et al. in 2012 described 2 cases of this malignant process in a 6-month-old boy (skin phototype I) and an 11-year-old girl (skin phototype II). For clinicians, the presence of melanonychia in children represents a serious diagnostic challenge. This is due to the fact that there are no reliable clinical, dermoscopic and histological criteria that provide a clear distinction between benign pigmented lesions and melanoma in situ in children.

At benign melanocytic hyperplasia Children sometimes exhibit clinical and dermoscopic signs that are considered possible manifestations of subungual melanoma in adults.

In adults alarm cause stripes of heterogeneous color that have blurred lateral borders, as well as the presence of cracks and separation of the nail plate, rapid expansion of the stripe, an increase or decrease in pigmentation over time. These signs may occur in children with melanonychia lentigo and melanocytic nevus due to activation of melanocytes in the nail matrix.

They are at children are not considered indicators for surgical excision of the lesion, but require careful observation and possibly a biopsy. Other clinical signs also indicate subungual melanoma in adults: the appearance of pigmentation after 30-40 years (it appears suddenly and a traumatic factor is excluded); the strip has a triangular shape; pigmentation not only on the nail bed, but also on the surrounding skin; dystrophy or destruction of the nail plate with bleeding in the area of ​​pigmentation; localization on one and/or two and/or three fingers; patients have a history of melanoma.

Besides, differential diagnosis between benign melanocytic hyperplasia and subungual melanoma in situ in children is often a major concern even for pathologists because most studies in this area have been performed only in adults. In children with melanocytic nevus of the nail bed, mild migration of melanocytes into the overlying layers of the epidermis and cellular atypia are often present.

Differential diagnosis between melanoma in situ, melanocytic nevus and lentigo of the nail bed is based on the presence in melanoma of a large number of atypical melanocytes, fusion of nests and pagetoid spread of cells into the suprabasal epidermal layers. In addition, differentiation between these diagnoses is also carried out by quantitative histological characteristics: with melanoma in situ in adults, there is a high density of melanocytes per millimeter (> 40), such parameters were not assessed in children.

Besides, melanocytic nail bed is differentiated from other benign diseases that can cause longitudinal melanonychia. It may be the result of the production of melanin by melanocytes (without increasing their number) matrix in people with dark skin color (people of the Negroid race, Mediterranean origin and others). Racial melanonychia has a pigmentation width, usually from 1 to 4 mm, less often up to 6 mm. It usually occurs on two to five fingers, less often on one finger of the hand; on the feet, one to ten fingers can be affected.

Longitudinal melanonychia may be mycotic in nature. The strip width is generally less than 4 mm. It has white or yellowish shades, but there may be other colors (brown, orange). Two to five toes may be affected. Distal lateral subungual onychomycosis remains the most common form of fungal infection. Its main features are onycholysis with hyperkeratosis and various forms of dyspigmentation.

:
a - Marginal pigmentation of the nail of the fifth finger in a 52-year-old patient.
Pigmentation appeared 2 months ago and was differentiated from melanoma.
Melanoma most often occurs in the area of ​​the first toes, while the pigmentation has a different shade and is often found on the skin near the nail.
In the area of ​​the fifth toes, post-inflammatory hyperpigmentation is more often observed, caused by traumatic factors of tight shoes.
b - Marginal pigmentation of the nail plate in the area of ​​the first toe of the right foot.
It can be regarded as post-inflammatory hyperpigmentation after resolution of inflammation of the lateral nail fold when wearing tight shoes.

Longitudinal melanonychia cause injury. Trauma resulting in hematoma remains the most common cause of melanonychia, which is usually dark brown or black in color. In addition, post-traumatic melanoma can form when wearing tight shoes due to repeated abrasions and friction. This melanonychia usually occurs on one finger. Nail pigmentation can also be caused by nail biting. This type of nail pigmentation gradually resolves after the traumatic factors disappear.

Longitudinal melanonychia may be associated with inflammatory skin diseases. This type of pigmentation can occur with lichen planus, psoriasis, and pustular diseases. Melanonychia can also be detected in Laugier-Hunzicker, Peutz-Jeghers syndromes, in patients with HIV infection, acanthosis nigricans, lupus erythematosus and scleroderma.

Longitudinal melanonychia occur as a result of the use of various drugs. Some drugs can activate melanocytes in the nail matrix and help increase the amount of melanin. This leads to the appearance of several longitudinal and/or transverse stripes on the nail plate of different colors from light brown to black. This may affect one nail or several. Pigmentation of the entire nail plate is possible. Drug-induced melanonychia most often appears 3-8 weeks after the start of use of this drug.

This pigmentation is usually reversible within 6-8 weeks, but may persist for several months after drug use is stopped. In addition, longitudinal melanonychia is caused by zidovudine (Retrovir), some chemotherapy drugs, psoralen, and antimalarials. Radiation therapy can also lead to subungual pigmentation.

Subungual melanoma accounts for approximately 4% of the total number of tumors. In this case, the frequency of damage to the fingers and toes is equal. A number of experts believe that the thumb is most susceptible to melanoma. A characteristic sign is darkening of the nail near the nail bed. Next, a tumor appears that begins to destroy the nail. Bloody fluid and pus are released.

About 20% of the presented type of melanoma are non-pigmented. That is, they contain little or no melanin.

Longitudinal melanonychia is detected in individuals with dark dermis: in almost all African Americans over 50 years of age and in 77% of African Americans over 20 years of age. Among other things, the longitudinal form occurs in 15% of Japanese people. It is also common among Latinos. In white Europeans it occurs only in 1% of cases. Melanoma is the 7th most common cause of cancer!

Other Features

At an early stage, subungual melanoma resembles panarica, paronychia, or subungual hematoma. This makes its diagnosis difficult. Most patients are admitted to clinics with metastases. At an advanced stage, nail melanoma resembles a mushroom-shaped tumor with ulcerations.

The color of the formation is bluish-red, there are dark inclusions. In some cases, the tumor resembles granulation matter. The development of the disease occurs in different ways: it can be slow with lymphogenous metastasis or have an aggressive course with rapid dissemination.

Diagnostic methods

A biopsy is used as a diagnosis. It makes it possible to accurately identify the cause of nail pigmentation. Patients who have longitudinal melanonychia on several nails should be observed by a doctor. In individuals with light dermis and one dark stripe on the nail, a biopsy should be performed. The method of 3-mm trepanobiopsy of the darkest area of ​​the pigmented strip in the area of ​​the nail matrix is ​​used. When a diagnosis is made, it is necessary to completely remove the lesion.

Treatment methods

• Melanoma under the nail is treated at the initial stage as follows: disarticulation of the distal phalanx is performed. Sometimes amputation has to be performed. If there are metastases in the lymph nodes, regional lymphadenectomy is prescribed.
• If, due to melanoma under the nail, metastases have spread to the regional lymph nodes, combined or complex treatment can be used. If the inflammatory process is indolent, it is necessary to consult an oncologist.
• Melanoma is often confused with melanonychia, but the pigmentation zone moves as the nail plate grows. In this case, it is of the “proximal border” type, which repeats the shape of the lunula. If you have melanoma rather than melanoma, treatment is not required.
• If the melanoma has an “in situ” appearance, the nail apparatus is removed and the finger is preserved. In the presence of metastasis of internal organs or lymph nodes, chemotherapy is used. It is carried out both in our country and in foreign clinics.

Causes

Often the growth of melanoma under the nail comes from a longitudinal stripe. It darkens, becomes wider, and covers the nail roller. The main reason for the development of the disease is finger injury.

Another reason is hematomas and taking medications that have side effects.

Important! If any pigmented longitudinal stripe appears, you should consult a specialist. It is easier to rule out melanoma under the nail than to treat it in its final stages.

List of pathological processes of the skin, among which differential diagnosis of primary melanoma of the skin should most often be carried out

Skin malformations		Juvenile melanoma (Spitz nevus) Blue nevus Halo nevus Dysplastic Nevi
	Hemangioma	Cavernous thrombosed hemangiomas
Benign skin tumors	Papiploma, keratoacanthoma, pyogenic granuloma (bothryomycomoma). angio-, dermato- and neurofibroma; various types of epitheliomas, adenomas and cystadenomas.
Precancerous tumors of the epidermis	Seborrheic keratoma, Bowen's disease
Malignant skin tumors	Squamous cell carcinoma, basal cell carcinoma, Kaposi's sarcoma, fibro-, leiomyo- and lymphosarcoma, primary skin lymphoma, adenocarcinoma of skin appendages.
Metastases of tumors of other histogenesis into the skin	Cancer of the lung, esophagus, pancreas, kidney, stomach, breast, ovary, melanoma.
Dermato-venereological diseases	Fungal infection of the nail bed of the fingers (onychomycosis); extrasexual chancroid.
Traumatic processes	Subungual and subepidermal hematomas

Classification of the disease

There is a special classification that allows you to describe subungual melanoma:

• A- this is the age, the peak incidence between 5 and 7 years of life, as well as the name of the ethnic groups - Americans, African Americans, Asians, in whom the tumor is most often observed;
• IN– this is the color (black or brown), as well as a width of 3 millimeters;
• WITH– change in the pigmentation of the nail strip or the absence of such a change after therapy;
• D– this is the finger as the most common area of ​​damage;
• E– this is the spread of the lesion to the lateral or proximal nail fold;
• F– this is a personal or family history of the tumor.

Lentigious type

Subungual melanoma of the acral-lentiginous type is more often found in people with dark skin; it can be recognized by comparing it with photos in medical reference books. It occurs in half of the cases. The affected area is under the nail. Elderly men are predisposed to developing the disease.

Growth is slow and unnoticeable. Often the tumor is discovered by chance. In view of this, treatment begins at the last stage. After the nail comes off, a serious localization of the tumor is revealed. Melanoma is often confused with a hematoma or wart. Onychomycosis is also disguised as a dangerous disease.

A number of African races have pigment spots that are considered precursors to melanoma. In people of the white race, the main cause remains trauma to the limbs. If there are hemorrhages in the phalanges of the fingers, you should immediately consult a specialist!

Survival Projections

At the first stage, the five-year survival rate is 74%. On the second – 40%. Factors that influence the stage:

• the presence of ulcerations;
• level of invasion according to Clark;
• race;
• stage at the time of diagnosis.

It is important to monitor the patient regularly. The patient must constantly inform about changes in the nail plate, compare the symptoms with the signs in the photo in medical manuals.

Conclusion

Melanoma under the nail is quite common. Its main reason is trauma to the area. A biopsy is used to identify the disease. In some cases, treatment requires amputation of part or the entire organ. For metastasis to the lymph nodes, lymphadenectomy is used.