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Heel melanoma is a rare condition, accounting for a maximum of 3.5% of the total malignant pathologies of this kind worldwide. The incidence percentage in different racial groups is similar. However, this variant of plantar disease is most characteristic for African Americans, Asians, and Latinos - 75%, 25%, and 10%, respectively. Melanoma affects men after 70 and women after 60 years of age. It mostly affects the big toes of the feet and hands.

Causes of nail melanoma

The cause of the appearance of melanoma under the nail is not sun exposure, as in skin melanoma, but the activation and proliferation of melanocytes in the nail matrix that produce melanin. Melanonychia mostly affects the distal nail matrix, where almost half of the melanocytes can become activated. Longitudinal melanonychia, accordingly, occurs due to the activation of dormant proximal melanocytes, their proliferation in the distal nail matrix. Researchers identify a series of reasons that individually or collectively can contribute to the development of nail cancer. These include:

  • Racial predisposition – individuals with darkly pigmented skin are physiologically prone to the disease.
  • Mechanical damage – repetitive friction hematomas.
  • Hormonal stimulation during pregnancy.
  • Reaction to inflammatory, infectious irritants of the nail apparatus.
  • Side effects of birth control pills.
  • Peutz-Jeghers syndrome (benign polyps in the small and large intestine, other organs. The pathology is benign).

Due to hypermelanosis, melanocytic pigmentation of the nail matrix epithelium intensifies, but without an increase in the number of melanocytes.

Melanocytic hyperplasia is a rare cause of longitudinal melanonychia. It occurs only in three variants: nevus, lentigo, melanoma. Invasive nail pathology and in situ (0 stage) are considered malignant.

Symptoms of nail melanoma

The nail tumor appears as a brown or black streak along the length of the nail plate. Early stages resemble a nevus or lentigo.

A characteristic sign of disease progression is that over several weeks or months, the pigmented streak under the nail undergoes significant changes. Main symptoms include:

  • Width expansion (more than 3 mm), especially in the cuticle area.
  • Irregular pigmentation of the nail.
  • Unevenness, blurred borders.
  • Extension onto the skin of the proximal and lateral nail folds.
  • Formation beneath the plate, somewhat elevating it. Sometimes the tumor resembles a wart.
  • Onset of nail plate dystrophy.

Acral lentiginous melanoma causes lesions in the nail bed, spaces between the fingers, and skin (finger area, palms, soles). Nail pathology has two stages of development:

  • Horizontal;
  • Vertical.

In the horizontal stage, the spot grows, affecting the front part of the nail plate, the nail fold, and the skin.

Non-pigmented nail melanoma often progresses for an extended period without any symptoms. The first signs emerge during the vertical stage: the growth infiltrates the tissue around the nail, causing deformation. Simultaneously, the appearance of the nail plate changes; it becomes dark, thin, starts peeling, and breaking. As the tumor actively grows, the nail gradually cracks, and the surface becomes uneven.

Possible complications of melanoma include:

  • Spread to other parts of the body.
  • During the vertical growth phase – nail dystrophy, ulceration.
  • Cosmetic deformation.

If you notice one or several similar symptoms, we strongly recommend visiting a doctor. They will confirm or rule out the diagnosis and prescribe necessary treatment.

Diagnosis of nail melanoma

The diagnosis of nail plate cancer involves a comprehensive set of measures, starting with a consultation with a specialist. The expert assesses the presence of pathology risk factors, hereditary predisposition, and gathers information about all signs, their duration, and the progression dynamics.

Next, the dermatologist carefully examines the affected area of the nail using dermatoscopy. This method specifically checks for new growth (symmetry, color, size). Dermatoscopy helps detect the disease at early stages and rules out involvement that does not require further examinations.

Later, considering all the signs, laboratory tests are prescribed, including a blood analysis from a vein, which will indicate the levels of proteins, enzymes, and detect tumor markers.

In the early stages of the development of nail disease, laboratory tests may show an incomplete clinical picture. Only during the active phase of nail cancer, significant negative changes are visible in the analyses (moderate and severe forms of anemia, increased erythrocyte sedimentation rate (ESR), decreased protein levels, etc.).

To establish a final diagnosis, a biopsy of the nail matrix and bed is necessary – the separation of a portion of the affected area for a detailed analysis.

Treatment of nail melanoma

The goal of treating nail cancer is the elimination of the tumor, combating cancer cells, and prolonging the patient's overall life.
It is a serious nail pathology, so it can only be eliminated through the complete removal of the malignant nail formation by surgical intervention. There are three options for eliminating the affected area:

  1. Removal of the tumor only (initial stage of the disease).
  2. Removal of the nail plate (beginning of the active phase).
  3. Amputation of the phalanx of the finger (late stages of the disease).

Sometimes, specialists recommend cryotherapy or laser removal of the formations. Such methods are effective only in the early stages.

If signs of nail melanoma are detected quickly, it can be successfully treated. The success of the treatment depends on various factors such as the location of the tumor, the stage, and the overall health condition. The chances of the patient overcoming the pathology in this case are high.

Stage IA nail cancer has a survival rate of 97% (after 5 years) and 95% (after 10 years). If the disease is diagnosed late (IV or final stages), the chances of survival after treatment are up to 20%, a maximum of 15% after 5 and 10 years, respectively.

Prevention of nail melanoma involves the following:

  • Protecting the extremities (hands, feet) from mechanical and physical damage.
  • Wearing warm clothing and footwear in cold weather to prevent frostbite (gloves, insulated shoes of a larger size than usual to avoid constriction).
  • Minimizing exposure to chemicals (for those working in specific places and in contact with chemicals).
  • Regular examinations for individuals genetically predisposed to nail melanoma.
  • Timely removal of nevi (benign skin tumors), regular medical check-ups, monitoring overall health.

Treatment for nail melanoma on the foot or hand is available at the "LeoDerm" medical center. To schedule a consultation with a dermatologist, you can contact the phone numbers listed on the main page of the website. Accurate diagnosis, fast and accessible analyses using innovative equipment, and quality service – you will receive all this at our clinic! We operate at two addresses: 29A Chervonoji Kalyny Avenue and 7 Zaliznychna Street. Take care of your health and come to "LeoDerm"!

The information in the article is provided for informational purposes and is not intended as a guide for self-diagnosis and treatment.
If you experience symptoms of an illness, please consult a doctor.