What should you know about ungual melanoma?

The melanoma may begin in the nail bed, nail matrix or nearby skin. A brown or black band can widen, develop uneven colour, or extend onto the surrounding skin. The nail may split, lift, bleed or become distorted, although these changes can also have non-cancerous causes such as injury or infection. A clinician examines the nail and the rest of the skin, then may remove a small sample for laboratory diagnosis. The assessment considers the band’s pattern, recent change and any signs of spread.

Arrange a prompt dermatology appointment for a new or changing dark nail mark, especially when it affects one nail or the pigment reaches the cuticle. Do not scrape, burn or repeatedly cover the area while waiting. Photographing the nail in good light can help show change over time. If melanoma is confirmed, treatment commonly involves carefully planned surgical removal; the exact operation depends on where the tumour is and how far it extends. Further assessment may include a sentinel lymph node biopsy or other staging tests. Read more about Melanoma, Surgical Excision and Skin Cancer Surgery.

Seek urgent medical advice if the nail area is rapidly changing, bleeding without a clear injury, persistently painful, ulcerated, or associated with a new lump or swollen lymph node. A dark mark after trauma still deserves review if it does not grow out with the nail. New neurological symptoms, breathing difficulty or severe weakness require emergency care rather than waiting for a routine appointment.

Ask which nail structures are involved, whether a biopsy is needed, how much tissue may be removed, and whether staging is appropriate. You can also ask how the nail may heal, which symptoms should trigger contact, and what follow-up plan is recommended after treatment.