What should you know about first stage early stage melanoma toenail?

A dark brown or black streak may run lengthwise through the nail, sometimes with uneven colour, widening, or pigment extending onto the surrounding skin. The nail can split, lift, or develop a persistent change that does not grow out as an ordinary bruise would. A mark under one nail deserves examination, especially when it changes or has no clear injury explanation. A clinician may inspect the nail, skin, and nearby lymph nodes, then arrange a biopsy so a laboratory can identify the cells and measure the tumour.

Stage one describes melanoma that remains localised. The exact stage depends on features such as tumour thickness, ulceration, and whether nearby nodes are involved; it cannot be confirmed from appearance alone. Read more about [Melanoma](/conditions/melanoma/).

Arrange a dermatology appointment promptly and take clear photographs showing the nail from above and the surrounding skin. Avoid covering the mark with polish before assessment, and mention any injury, change in size, bleeding, tenderness, or previous skin cancers. Diagnosis commonly involves [Surgical Excision](/treatments/surgical-dermatology/excisional-surgery/) or another biopsy approach. If melanoma is confirmed, [Skin Cancer Surgery](/treatments/surgical-dermatology/skin-cancer-surgery/) may remove the lesion with a margin of nearby tissue. Some people are considered for [Sentinel Lymph Node Biopsy](/treatments/diagnostics-and-staging/sentinel-lymph-node-biopsy/) based on the tumour findings.

Seek prompt medical review for a new or changing dark nail streak, pigment spreading onto the cuticle, a nail that repeatedly bleeds or breaks, or a sore that does not heal. Seek urgent care for uncontrolled bleeding, rapidly increasing swelling, severe pain, or signs of infection such as spreading redness and fever. These warning signs do not establish melanoma, but delaying assessment can delay diagnosis.

Ask whether the change needs a nail-unit biopsy, which features determine the stage, how much nail or tissue may need removal, and whether a specialist pathology review is appropriate. Ask how the toe will heal, how nail growth may change, and what follow-up schedule you will need. Discuss whether any additional scan or treatment is relevant to your findings.