Can You Get Skin Cancer on Your Nails?

You’re probably well aware of skin cancer and the best way to prevent it -- sunscreen, shade, protective clothing, skin self-exams, no tanning beds – but you might not know that you can get skin cancer on your fingernails and toenails!

Melanoma, the deadliest type of skin cancer, can develop under and around both fingernails and toenails. While it’s considered rare, accounting for 3.5% of melanoma cases, it’s more common in people with skin of color, and is often diagnosed at a more advanced stage than melanoma on the skin. This is in part because it can be initially misdiagnosed as other issues, like a common fungal infection.

Melanoma usually starts as a dark spot or streak on the nail, typically the big toe or thumb, but it can be any digit. The spot or streak is often at the bottom of the nail next to the cuticle, and you may even think it’s a bruise. Sometimes it may be pink or red or look like a sore that won’t heal.

There are a few types of melanoma that can develop on and around the nail. Some start under the nail plate (ungual melanoma), some start in the skin next to the nail plate (periungual melanoma), and some originate in the area where the nail starts to grow, also considered the “nail matrix” (subungual melanoma). A different type of cancer, squamous cell carcinoma, can also occur on the nail.

What started as a small spot or streak may continue to grow, cause the nail to separate from the bed, or cause skin darkening near the nail. If you notice any new or changing spot or a spot that won’t heal on your nail, see your doctor. The doctor will check it out, ask how long it’s been there and if it’s changed any over time. If melanoma is suspected, the next step would be a biopsy of the nail matrix and/or the nail bed. If positive for cancerous cells, your doctor will run other tests to see if the melanoma has spread elsewhere in the body.

The standard treatment is to surgically remove the affected area – typically the whole nail -- and if severe enough, a portion of the toe or finger itself. Discussion about other therapies like radiation and chemotherapy depend on the stage of diagnosis.

The main difference with nail-related melanoma is that it’s not caused by sun exposure, which means it’s hard to prevent compared to melanoma on the skin. A family history of melanoma or previous nail trauma may make you at higher risk.

If the melanoma on your nail is caught early before it has spread, the outlook is very good. The best thing you can do preventively is to inspect your nails regularly and contact your doctor if you see discoloration, red spots, changes or any areas that aren’t healing.

Azeen Sadeghian, MD, FAAD
Baton Rouge General Physicians - Dermatology
(225) 333-3614