Here are three examples of melanoma in-situ (early stage melanoma).

Here are three examples of melanoma in-situ (early stage melanoma).

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.

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.

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.

Note the surrounding pigment, indicative of an advanced stage melanoma.

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.

This photo shows benign longitudinal melanonychia in a patient with multiple pigmented bands.

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

Dr. Dana Stern

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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