What should you know about acral lentiginous melanoma toe?

It may show as a changing dark patch or nail streak, but trauma, infection and benign pigment can cause similar appearances. Prompt examination and, when indicated, biopsy distinguish these possibilities.

On toe skin, the condition can present with an asymmetrical patch, uneven colour, an irregular margin or an area that progressively enlarges. Beneath a toenail, it may produce a lengthwise pigmented band that widens or becomes less uniform, with splitting or lifting of the nail.

Pigment reaching the cuticle or skin beside the nail can be concerning. Acral lentiginous melanoma may have these features; however, none proves that a particular toe mark is melanoma. Bruising usually grows out with the nail, while persistent pigment arising from the nail-forming area needs direct assessment.

Remove nail polish before the appointment if practical and explain any injury, footwear pressure or treatment for fungal infection. Bring dated photographs if they show evolution. The dermatologist examines the toe, nail and nearby nodes and may use magnification to inspect the pigment pattern.

A biopsy must sample the correct part of a suspicious lesion, including the nail-forming tissue when relevant, and is performed by a clinician familiar with nail anatomy. If melanoma is confirmed, surgery is planned around tumour depth and location. Lymph-node staging or systemic therapy may be considered according to the pathology and wider assessment.

Request prompt review if a toe patch is expanding, changing shape, developing several colours, bleeding or failing to heal. The same applies to a new or widening streak in one toenail, unexplained nail destruction, or pigmentation extending beyond the nail.

A painful red swollen toe with pus or fever may represent infection and also needs timely care. After a melanoma diagnosis, report a new lump in the groin, persistent unexplained symptoms or a rapid decline to the treating team; urgency comes from the new warning feature, not from assumptions about its cause.

Ask whether the pigment begins in the nail or the skin, which biopsy approach will preserve diagnostic accuracy, and how the toe will be protected while it heals. If cancer is found, discuss the surgical plan, expected effect on walking and footwear, the role of lymph-node testing and the follow-up schedule.