What should you know about melanoma under toenail?

Pigment beneath a nail may follow an injury, repeated pressure, a benign mole, bleeding, or infection. Melanoma is a cancer of pigment-producing cells and can begin in the nail unit, sometimes without a remembered injury. It may look like a brown or black line that widens, develops uneven shades, reaches the surrounding skin, or changes while the nail grows. The appearance alone cannot confirm the cause.

Arrange a dermatology assessment for a new, persistent, widening, or irregular mark. The clinician may examine the nail and skin with magnification, compare photographs, and decide whether a biopsy or Surgical Excision is needed. Do not scrape, bleach, or repeatedly cover the area with polish; take a clear photograph and note when the change began. If melanoma is confirmed, staging may guide surgery, Sentinel Lymph Node Biopsy, or other care such as Immunotherapy.

Seek prompt medical review when pigment spreads onto the cuticle or nearby skin, the band changes quickly, the nail becomes distorted, or bleeding, pain, swelling, or a persistent sore develops. An appointment is also sensible when a mark remains after an apparent bruise should have grown out with the nail. Urgent assessment is needed for severe pain, spreading redness, or drainage, which can signal infection or another nail problem.

Ask whether the mark is growing out with the nail, whether dermoscopy or a biopsy is appropriate, and what changes should trigger review. If testing confirms melanoma, ask how far it extends, whether nearby lymph nodes need assessment, and how follow-up will be organised.