What is Subungual Melanoma?
Subungual melanoma is a certain known kind of melanoma that infects the skin under the nail bed, it is more commonly to be seen in dark-skinned people. To be more specific as a description, we should know that subungual melanoma causes dark colored stripes along the whole length of the nail plate. However, we have to keep in mind that having a dark nail stripe is not considered enough cause to diagnose melanoma. There are additional signs beside a dark stripe to be considered as subungual melanoma and a dermatologist should definitely evaluate it.
Subungual melanoma is often diagnosed late in the course of disease, because of its low incidence and its appearance that can commonly be mistaken for other conditions, for that reason we should be familiar of the additional signs other than the dark colored stripes, like for example it commonly occurs at age 50 or older, and it can be seen in the thumb, index finger, or great toe. It has those blurred borders, and finally there must be some kind of History with melanoma.
Symptoms of Subungual Melanoma
For full description, subungual melanoma often occurs as a pigment band. For several weeks to few months, with the progression of the condition, the pigment band may begin to get wider, particularly almost at its end and becomes more irregular in pigmentation with light or dark brown extends to invade the adjacent nail fold (Hutchinson sign) and it may develop a nodule, at this stage sometimes it may ulcerate or bleed, furthermore it can make the nail much thinner, or it sometimes cause some kind of cracking or even it may distort of the nail plate. However, about 50% of all the cases subungual melanoma is not pigmented; it is more like to be amelanotic. Ungual melanoma may form a nodule right under the plate of the nail. It also sometimes looks like a wart. The patient usually feels no pain, but an advanced tumor infecting the bones beneath the affected area may cause severe pain.
Subungual Melanoma Causes
There are few common causes that can lead to the invasion of subungual melanoma and they can be restricted as follow, firstly any severe Trauma affects a particular finger/toe that can lead to a chronic situation or a foreign body stacked into the finger/toe nail, this cause is considered one of the main causes which plays a functional role in generating the subungual melanoma, another cause is the long periods in which one is exposed to the sun rays or some kind of radiation therapy for other types of cancer, furthermore the ill-fitting footwear which is considered as a possible cause, finally there are a serial of medical situations which can lead to subungual melanoma such as hormonal disorders, AIDS and the chronic fungal infections of the nail bed.
Diagnoses and Prognosis
As an average, we can tell that 2-3 years pass before seeking any medical evaluation for a nail with a possible infection by SM. Diagnosis can be identified by biopsy, and additional clinical features may be indicated. We have also to keep in mind that repeated biopsy might be warranted if the initial specimen is inconclusive, or we may even have to use of specific medications.
Clinical evaluation may include dermoscopy. It is very helpful to carefully evaluate any pigmented banding shapes besides the free edge of the nail. We can use some special kind of a gel, such as ultrasound gel as a type of immersion medium, these kinds of products decrease viscosity and fill any cavities while permitting the dermatoscope to stay on the nail plate without rolling off.
In addition to all the previously mentioned ways to examine the infected area there is another assessment includes examining the axillary and inguinal lymph nodes, using this way may involve using of computed tomography. Specifically, for the classification of melanomas which can be very challenging in the nail because of its unique anatomy nature.
Subungual Melanoma Pictures
Take a look at some of these pictures of subungual melanoma:
Subungual Melanoma Treatment
Fortunately, there may be several treatment options available for nail melanoma and they are up to the specific stage of the diagnosis. Each case must be handled individually and the treatment supervisor must review the full pathology report and all the available knowledge about the medical history of the patient when deciding the treatment type, and to choose the best course of recovering. In addition, if melanoma is newly diagnosed, to know more about treatment options is truly considered as an urge and a must.
For Subungual melanoma treatments there are several kinds depending on the patient situation, the patient medical history, pathology report, and at which stage melanoma was diagnosed. The first way to be mentioned is Surgery that is considered as the main arrangement that can be done for the early stages of melanoma and for removing the isolated melanoma affected area. There are several different types of surgeries that are usually used to treat this kind of cancer. The second way is Clinical trials, which are some kind of researches and studies to experience new methods of cancer treatments. There are many kinds of clinical trials can be done at any given period, and most experts can truly state that for a late-stage diagnosis, clinical trials are the best treatment option. For the third kind of therapy, we can name one unique type, which is targeted therapy. A treatment method where drugs can distinguish between the abnormal part of tumor cells and the normal ones and target the infected area. Fortunately there are many targeted therapies have been approved to be used in curing various kind of melanoma. Finally, there is an interesting kind of treatment called Chemotherapy, which is a type of systemic treatment used directly to destroy melanoma cells all over the body. Unfortunately, Chemotherapy has a very limited usage until now in the treatment of melanoma and developing this method of treatment is still in progress.
Side Effects of the Treatments
As we already discussed the several kinds of treatment, we find it very essential to speak up about the side effects of these treatments and its bad consequences on the patient’s health situation. As with any kind of cancer therapies, patients may experience side effects from the treatment arrangements. Keeping that in mind, it is very important to remember that everyone reacts differently to treatment. The most common side effects of melanoma treatment are not limited, but we will try to mention few, like for example some kind of pain, scarring, lymphedema, infection that can be a result of the severe weakness of body immune, fatigue, nausea/vomiting, diarrhea and constipation.