Melanoma of the nail or subungual melanoma (Latin "melanoma", from the ancient Greek "Μέλας" - "black" + "-οΜα" - "tumor") is a malignant disease that develops from specialized skin cells (melanocytes) that produce melanin. It occurs not only on the inside of the hand and the sole of the foot, but also on the nails (most often the nail of the thumb or toe is affected, but other nails and fingers are not excluded).
How common?
Among all cancers, the incidence of nail melanoma is about 3% in women and about 4% in men. Previously, it was always believed that subungual melanoma could occur mainly in the elderly, but now this malignant tumor has begun to be observed.increasingly in young people.
Compared to other types of cancer, nail melanoma grows much faster because the body has very little or no response to it. Therefore, according to statistics, after malignant tumors of the lungs, this disease takes second place.
Views
There are several types of subungual melanoma:
- developed from the nail matrix (the area of skin located under the root of the nail, responsible for the production of new tissues);
- appearing from under the nail plate (the main part of the nail that protects the soft tissue of the finger);
- evolved from the skin next to the nail plate.
Causes of nail melanoma
Melanoma of the nail affects people of all races, regardless of country of residence and status. In fact, at the present time, science has not fully established the causes of this disease. However, it is still possible to identify factors that affect the transformation of he althy cells into malignant ones. Risk groups include:
- people who have fair skin, blue eyes, lots of pink freckles and blond or red hair;
- those with a history of sunburn (even if it was in childhood or adolescence);
- people with a family history of subungual melanoma more than once are 3-4 times more likely to develop the disease;
- people over 50;
- regularlyexposed to ultraviolet rays (including from artificial tanning equipment);
- those who suffer from a lack of vitamins, rest and have weak immunity, as well as those who work with aggressive environments and chemicals, are at risk. Next, find out what melanoma looks like.
Signs of disease
In most cases, as the disease progresses, the symptoms of nail melanoma also change. Therefore, it is extremely important not to lose sight of the first signs characterizing the onset of a malignant formation in time, because, as a rule, the early development of the disease is asymptomatic. But in the later stages, the following signs begin to appear:
- A dark pigment spot appears under the nail plate. This spot may look like a longitudinal strip on the nail bed. Sometimes the onset of melanoma of the nail may be preceded by a minor injury to the finger of the patient who did not consult a doctor in a timely manner.
- As a rule, within a few weeks or months there is an increase in the spot under the nail. It begins to change color to light or dark brown and becomes wider at the cuticle growth area, and eventually can completely cover the entire area of the nail.
- The malignant neoplasm begins to spread to the nail fold that surrounds the nail plate.
- Bleeding ulcers and developing nodules begin to appear, leading to deformities, cracks and thinning of the nail plate. And also from underthe nail begins to ooze pus.
So you already know what melanoma looks like. The above signs will allow the doctor to suspect pathological destruction of epidermal tissues and the presence of this dangerous disease in the patient. In some cases, the specialist who examines the patient confuses a dermatological ailment with a panaritium of an infectious nature of origin and prescribes surgical debridement of the affected skin surface.
Precious time is being wasted that should have been used for tumor therapy, and the signs of cancer are returning again and with an even more vivid manifestation of the clinical picture.
Since very often neoplasms under the nail have no color, in half of the cases of this disease, unfortunately, patients notice external signs too late. This kind of melanoma of the nail can only be noticed if a nodule begins to form under the plate, which lifts the nail up.
It should be noted that both arms and legs are equally affected by this disease. If a malignant tumor has spread to the sole, then it provokes obvious discomfort during movement. In the early stages, this disease is so asymptomatic that doctors sometimes confuse it with common skin warts.
Stages
So, let's highlight all the stages of nail melanoma:
- First, damage is observed on the surface of the skin, the nail plate reaches a thickness of 1 mm, however, this does not cause concern forpatient.
- During the second stage, subungual melanoma reaches a thickness of 2 mm and begins to spread along the nail plate, changing pigmentation. The stain expands, darkening as it does so.
- After that, malignant cells begin to spread to nearby lymph nodes, and damage to the skin around the nail is often observed.
- At the fourth stage, metastases begin to appear in the liver, lungs and bones.
Everyone should remember that the symptoms of subungual melanoma are important to recognize in time.
Diagnosis of pathology
The reason for a visit to a specialist should be any pigmentary change in the nail plate, especially if it has increased in size (up to 3 mm or more), because nail melanoma at an early stage often has ambiguous signs. To determine the malignancy of a neoplasm under the nail, qualified specialists use a dermatoscope - a special optical microscope used to translucent the stratum corneum of the nail and skin to assess pathological changes visually: the degree of spread, size and thickness of the tumor. Read on to learn how to tell a subungual melanoma from a hematoma.
Biopsy
If a malignant origin of the tumor was detected during dermatoscopy, then the next step the doctor prescribes an additional biopsy, which allows you to remove the suspicious formation along with the area of the surrounding skin and examine the tissue section in the laboratory under a more powerfulmicroscope and determine unambiguously whether it is a malignant tumor or a normal hematoma.
Sometimes it happens that a histological examination refutes the presence of nail melanoma in a patient and diagnoses other diseases: subungual hematoma, usually due to bleeding or bruising, fungal infection, purulent granuloma, paronychia, squamous cell carcinoma. If a malignant tumor is nevertheless found during a histological examination, then the final stage is an ultrasound examination (ultrasound) of the organs and tomography to exclude the presence of metastases. How long does subungual melanoma take to develop? More on that below.
Treatment of nail melanoma
Melanoma, together with part of he althy tissues, as well as subcutaneous fat and muscle, is completely removed (excised) surgically. Sometimes it happens that melanoma has already spread greatly. Then, together with it, the nail plate is completely removed, and in especially advanced cases, the entire phalanx of a finger or toe is also amputated. Also, if a patient is diagnosed with nail melanoma, then he is prescribed a biopsy of the lymphatic tissues, which will help doctors determine the extent to which the malignant tumor has spread to the local lymph nodes. Subungual melanoma of the thumb is common.
If metastases are found as a result of a histological examination, then they are additionally removed. And also, in addition, a complete removal of the lymph nodes is prescribed, and then, depending on the individualcharacteristics of the patient's body, complex or combined treatment is prescribed.
Additional methods
Additional methods of dealing with this disease are:
- Chemotherapy.
- Radiation therapy.
- Laser therapy.
If nothing was removed except for the nail plate, then after the operation to remove melanoma, the nail grows back.
Forecast
If a patient in a medical institution was provided with timely and competent assistance, then the prognosis for him will be very favorable.
If the patient did not bother to turn to a qualified specialist in time, whose visit was delayed for a long period, then the tumor can already metastasize and the treatment process in this case becomes much more complicated, because the chances of survival decrease. Approximately 15 to 87% of patients survive five years after diagnosis.
Therefore, value your he alth, do not neglect it and immediately consult a doctor at the first symptoms.
