Nail & Skin Disorders

A Day in the Life of a Nail Expert: Melanoma

In this month’s column, Dr. Stern talks about melanoma and the nail tech’s role in referring clients to a physician.

Here are three examples of melanoma in-situ (early stage melanoma).
<p><span>Here are three examples of melanoma in-situ (early stage melanoma).</span></p>

Melanoma is a type of cancer that most people tend to associate with the skin. However melanoma can arise in the nail as well. Melanoma occurs when the pigment-producing cells in the nail (melanocytes) begin to grow in an uncontrolled fashion. Although melanoma in the nail appears as a single pigmented brown or black band, most brown or black pigmented bands in the nail are benign or non-worrisome. The other causes of single brown pigmented bands in the nail are usually either benign moles or simply the pigment cells “waking up” and producing pigment much like when a new freckle appears in the skin.

Unfortunately, early melanomas are very difficult to distinguish from benign pigmented bands and that is why it is imperative to see a dermatologist for a thorough exam and consultation when it is unclear what the diagnosis is. 

This is the nail of a 29-year old female with advanced melanoma who was covering up her nail with acrylic because she thought it was ugly.
<p><span>This is the nail of a 29-year old&nbsp;</span><span>female with advanced&nbsp;</span><span>melanoma who was covering&nbsp;</span><span>up her nail with acrylic&nbsp;</span><span>because she thought it was&nbsp;</span><span>ugly.</span></p>

Pigmented bands in the nail are common and usually normal especially in people with darker complexions. This is because the nail, similar to the skin, has pigment-producing melanocytes. These cells mostly reside in the half moon region of the nail (the distal matrix). Therefore, people with a lot of melanocytes in their skin tend to have a higher number of these pigment-producing cells in their nails and will often have multiple pigmented bands in the nails.

Note the surrounding pigment, indicative of an advanced stage melanoma.
<p><span>Note the surrounding&nbsp;</span><span>pigment, indicative of an&nbsp;</span><span>advanced stage melanoma.</span></p>

Multiple pigmented bands are usually non-worrisome. When stimulated, these cells begin to produce pigment, appearing as a brown, length-wise band in the nail. So what stimulates these cells? Trauma to the matrix region is a definite stimulator. Any trauma to the cuticle area can result in stimulation of these pigment-producing cells because the cuticle lies directly over the area where the melanocytes reside. Aggressive and repetitive cuticle pushing, cutting, picking, or biting can stimulate these pigment-producing cells to wake up and start making pigment.

This photo shows benign longitudinal melanonychia in a patient with multiple pigmented bands.
<p><span>This photo shows benign&nbsp;</span><span>longitudinal melanonychia&nbsp;</span><span>in a patient with multiple&nbsp;</span><span>pigmented bands.</span></p>

If caught early, nail melanoma is curable. Unfortunately, nail melanoma tends to be diagnosed late. Nail technicians are frequently on the “front line” and can be instrumental in recommending referral to a physician for treatment. This action can be life-saving!

WHAT TO DO IF YOU SUSPECT A CLIENT HAS A NAIL MELANOMA:

  • Refer to a dermatologist. It is always a good idea to have a local dermatologist’s card readily available in your salon. Your client will appreciate your professional concern.
  • Do not cover or mask the abnormal nail with an artificial nail or polish. This can result in a delay in diagnosis.
  • When in doubt, discuss your concerns openly with your client. You can keep a copy of this article with the photos to compare and show your client if you are having difficulty communicating your concerns.

WHAT TO LOOK FOR:

As a nail technician, you are not expected to be a pigmented lesions expert, but there are certain red fl ags that should alert you to refer your client to a dermatologist.

  • A single pigmented band that is brown or black in color on a single nail
  • There is brown pigment on the surrounding skin (around the nail)
  • The band is on the thumb, index finger, or great toenail (the most common digits to have melanoma).

Dr. Dana Stern
<p>Dr. Dana Stern</p>

WHAT DERMATOLOGISTS DO:

Dermatologists treat skin, hair, and nails. I am a board-certified dermatologist and I specialize in the treatment of nail disorders including nail infections, inflammatory diseases of the nail, cosmetic issues related to the nail, cancers of the nail, and sportsrelated nail injuries. I also perform surgery on the nail including biopsies and excisions.

Most of my consults are from other dermatologists, physicians, or patients who have read about me. I also see patients referred from nail salons. I love the fact that my day is not predictable. I am constantly meeting new patients from all walks of life and I never know what interesting case awaits me when I enter the examination room.


Read previous “day in the life” articles by Dr. Stern at www.nailsmag.com/nailexpert.

Contact Dr. Stern with your questions via Facebook (www.facebook.com/danasternmd) or Twitter (@DrDanaStern).

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