Subungual Melanoma: What You Need to Know

May 1, 2019
Sharon Marston

Karolina Jasko didn’t notice or worry about the dark vertical streak on her nail, which you can see peeking out underneath the polish on the bottom right portion of her thumb nail near the cuticle. An unrelated infection led her to see a doctor, who urged her to see a dermatologist. Courtesy Karolina Jasko

Karolina Jasko has a family history of melanoma, so she’s no stranger to paying attention to her skin. Her mother — who battled the deadliest form of skin cancer twice and recovered — has always been vigilant about checking Jasko’s moles for any changes.

But melanoma was still able to sneak up on Jasko in a spot neither she nor her mom suspected: one of Jasko’s nails.

Experts like Dr. Vishal Patel, assistant professor of dermatology at the George Washington University School of Medicine & Health Sciences in Washington, D.C., worry such cases may be on the rise with the popularity of gel manicures that require the polish to be hardened under ultraviolet light.

“It’s like tanning beds for your hands,” Patel, who is also the director of the cutaneous oncology program at the GW Cancer Center, told TODAY. He was not involved in Jasko’s case, but commented in general.

“We’re seeing a lot of patients having not only melanomas, but all types of skin cancers around the finger tips and the cuticles.”

Jasko, 21, who is now a student at the University of Illinois at Chicago, first became aware of the unusual spot in 2016 when she was a senior in high school. She’d been getting her nails done once or twice a month for a couple of years, complete with acrylics — artificial nails applied on top of her natural nails — plus a gel polish that was cured with UV light.

When the acrylics were removed during one particular visit, the technician pointed out what seemed to be a bruise on her right thumb nail. It looked like a perfectly straight thin vertical line drawn with a pencil from the top to the bottom of her nail, with “a purplish tint” to it, Jasko recalled.

She didn’t think much about it. But about a week later, her nail became infected, swollen and red, which led her to see her doctor. The infection didn’t alarm him, but the mysterious streak on her nail did.

Jasko was immediately referred to a dermatologist who told her she needed to undergo a biopsy that same day at Northwestern Memorial Hospital in Chicago.

“It was overwhelming because everything happened so quick,” Jasko said. “It was so scary… My mom was like, ‘I can’t believe that I never even thought that it could be in your nail.’”

The portion of her thumb nail with the line was removed during the biopsy, which confirmed it was melanoma. Jasko had to return for surgery to remove the whole nail matrix. Doctors told her it was possible they might also have to amputate the whole thumb, but were able to save the digit. A skin graft from her groin area covered her thumb, which no longer has a nail.

The nail infection — which was unrelated to the melanoma, but led Jasko to see a doctor — may have saved her life, doctors told her.

“They still don’t know where the infection came from. They said that was like a sign from God… because if I would have waited longer and not come in with that, it could have been possible the melanoma would have spread,” Jasko said. She went on to become Miss Illinois 2018 and competed in the Miss USA pageant.

Doctors successfully removed all of the skin cancer from Jasko’s thumb. She no longer has a thumb nail after surgery to remove the nail matrix.Courtesy Karolina Jasko

WHAT TO KNOW ABOUT NAIL MELANOMA

Melanoma on the extremities — nails, hands and feet — is the rarest subtype of the skin cancer, accounting for less than 5 percent of all melanomas, Patel said. But it makes up about a third of all the melanomas that African Americans, Indians, Asians and other people with darker skin develop, which is a ten-fold increase compared to the general population, he noted.

This type of cancer — called acral lentiginous melanoma — tends to be more aggressive than other melanomas. It killed reggae legend Bob Marley at 36 after it showed up as a dark spot under his toenail.

The main symptom is melanonychia, or a pigmented vertical streak on the nail. Some people have likened it to a line drawn by a Sharpie. That doesn’t mean it’s always automatically worrisome because such streaks are much more common in patients with darker skin, Patel noted.

“When you have multiple, it’s reassuring because that may be a ‘signature’ of your nail beds,” he said.

But if a vertical stripe suddenly appears on a nail or it’s changing, that’s something a doctor should check out. Pigment extending from the nail portion onto the cuticle and nearby skin, which is called a Hutchinson’s sign, is also of concern.

Some doctors say nail melanoma often develops on the thumb of one’s dominant hand, or big toe of one’s dominant side, but Patel has seen it on all digits and believes all of the nails are equally potentially affected.

Examples of what nail melanoma looks like.Courtesy Debby McCord Thornton (bottom left) and the Journal of the American Academy of Dermatology

This type of melanoma is more driven by genetics and family history than sun exposure, but people should still follow sun-safe practices, he added:

  • Be careful about UV exposure, including at the nail salon. Wear fingerless gloves with an ultraviolet protection factor or apply sunscreen to your hands at least 15 minutes before a gel manicure.
  • When outside, apply sunscreen to the whole body, including around your nails and on your hands.
  • Wear sunscreen and possibly gloves during your daily commute: “If you’re a driver who has your hands out in a one-and-a-half-hour commute, you’re getting UV radiation exposure right to the backs of the hands and the nails,” Patel said. “Some of these things sound crazy, but the cumulative exposure over time [matters].”
  • Remove nail polish before going to your annual skin check so a doctor can see your nails.

With Jasko’s family history of melanoma, doctors can’t say how much of a role her regular UV exposure at the nail salon played. She now paints her nails with regular polish and skips the gel manicures. She also gets her skin checked every four months and is doing well.

“I’m very thankful they saved my thumb and that nothing worse happened,” Jasko said.

 

/ Source: TODAY

By A. Pawlowski

 

 

The Doctors CBS

The Doctors share what to look for with a subungual melanoma, which Miss Illinois USA 2018 Karolina Jasko discovered she had after going to the nail salon.

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