What should you know about bruised toenail melanoma?

A subungual bruise commonly follows impact or repeated pressure and tends to move toward the tip as the nail grows. Melanoma of the nail unit may appear as a brown or black band, widening or becoming irregular, or as pigment extending onto the surrounding skin. Lack of remembered injury does not prove melanoma, and an injury does not exclude it. A clinician may use dermoscopy and compare the mark over time; a biopsy may be needed when the pattern remains concerning. Melanoma is a cancer of pigment-producing cells, so a changing nail mark deserves attention without assuming the diagnosis.

Arrange a dermatology appointment promptly for a new, changing, or unexplained dark band, especially if it affects one nail. Photograph the nail in clear light and note when it appeared, any injury, and whether the pigment is moving with growth. Do not scrape, pierce, or apply bleaching products to the nail. If melanoma is confirmed, care may include Surgical Excision or Skin Cancer Surgery; further treatment is guided by examination and pathology. Sentinel Lymph Node Biopsy, Tumour Removal Surgery, Immunotherapy, and Follow-Up After Cancer Treatment may be relevant only in selected cases.

Seek prompt specialist review if a band widens, develops several shades, has an uneven edge, or reaches the cuticle or nearby skin. Arrange earlier care for bleeding, ulceration, a persistent lump, or a nail that changes without settling after an injury. Urgent care is appropriate for uncontrolled bleeding, rapidly increasing swelling, severe infection signs, or severe pain. Brain Metastases are not a sign to diagnose from a nail mark; new neurological symptoms in someone already treated for melanoma need urgent medical attention.

Ask whether the mark is moving with nail growth, whether dermoscopy or biopsy is needed, and what change should trigger an earlier review. If testing finds melanoma, ask about its depth, whether surgery is sufficient, and how follow-up will be planned.