Subungual Melanoma – Causes, Symptoms, Treatment, Diagnosis

Subungual Melanoma – Causes, Symptoms, Treatment, Diagnosis






Melanoma is the medical term given for Cancer. Cancer that develops in the nail unit is known as subungual melanoma. Melanoma can also occur on the palms and even on the soles. Subungual melanoma is also known as nodular melanoma. Nail melanoma can affect either your thumbnail or toenail. Cancer that occurs on the nail matrix is subungual melanoma. In case it occurs on the nail plate it is called as ungual and if it occurs beside the nail plate it is periungual melanoma.

Risk Factors :

• It is very rare to get melanoma in your nail matrix. Less than 1% of melanoma occurs in the form of subungual and often it targets white people, although it may occur in black people also.


• People with deep pigment are prone to subungual melanoma.


• Subungual melanoma occurs in the age ranging from 40-70 years.


• Trauma or injury to the nail is definitely a risk factor for melanoma.

Occurrence :

As said already, subungual melanoma is a rare phenomenon.

About 1-3% of people affected with melanoma can get subungual melanoma.

Subungual Melanoma Causes :

Cancers like nodular melanoma and desmoplastic melanoma can cause subungual melanoma. In some cases acral lentiginous melanoma can also affect nail matrix. In rare cases, hard blow or trauma to the nail can cause subungual melanoma.

Symptoms Of Subungual Melanoma :

• A band of pigments slowly appears on the nail plate. It does not happen overnight but is a gradual process. It may take several weeks or even months for the changes to get noticed. The pigment band becomes wide on the endings (cuticle) and is often irregular in pattern. The color of the pigment band can be in varying degrees of brown.


• After some weeks, the pigment band can progress to adjacent nail fold. In some cases the nodule may start bleeding appearing like ulcerous growth.


• Nails can crack in specific points and for some people nail can become thin and for others the nail gets distorted moving away from the nail plate.


• Often, subungual melanoma does not cause pain. In very rare cases if the Tumor spreads to the underlying tissues and bones it can be painful.

Diagnosis :

If there is any changing pattern of the toenail or thumbnail you need to check with your health care provider. Pigment band measuring more than 3mm in length can be subungual melanoma. Dermatologist can examine the nail with special device to observe color changes, expansion of the width and space changes. The lines of band pigment will not run parallel to one other like normal nailing pattern. If the doctor is doubtful of the diagnosis, he may order for biopsy of the affected nail matrix. A small tissue sample is collected and tested in the lab for the presence of cancerous cells. The pathologist would also clarify whether the melanoma is invasive or in-situ.

Subungual Melanoma Treatment :

Local excision of the affected nail-bed is done if the melanoma is less than 1mm in breadth. Subungual melanoma is often removed by cutting off the entire nail matrix. In severe cases if the melanoma has spread intensely, the toe or affected finger is also removed. In rare cases the cancer would have spread to the nearby lymph nodes also and treatment is done as per the severity of the stage of cancer. Chemo and radiation are considered as last option if the cancer has metastasized to other areas.

Prognosis :

Patients with subungual melanoma where the cancer has not metastasized can live long. In this case since only the nail is affected and no other symptoms are present, often it gets delayed to diagnose it and get it treated. By then, the cancerous cells could have spread to the bones underneath and also to the nearby lymph nodes. Survival rates depend on the extent of spreading of cells and how far it has affected. Hence prognosis is poor in such cases.

Nodular Melanoma – Symptoms, Causes, Treatment, Diagnosis, Pictures

Nodular Melanoma – Symptoms, Causes, Treatment, Diagnosis, Pictures






Melanocytes are pigment cells that produce a special pigment called melanin. Melanin is responsible for deciding the skin color which is found in the underneath layer of epidermis. Melanoma is the term given for Cancer that develops on the melanocytes. Nodular melanoma appears on the skin in the form of large sized mole. It occurs largely on fair complexioned people and is a type of Skin Cancer. It is difficult to detect and diagnose nodular melanoma since it resembles a mole causing no symptoms. Melanoma is characterized with irregular borders, change in color and growing size of lumps. In some cases, nodular melanoma spreads to nearby parts and lymph nodes causing complications. Treatment for nodular melanoma is surgical excision of affected skin area.

Who Are At Risk ?

Anyone can get nodular melanoma irrespective of age and sex. People belonging to white origin or fair skinned people and those with light hair color are at risk. Further people born to parents with melanoma and those with large number of moles in their body are at high risk of nodular melanoma. People with large sized moles and those with funny shaped moles are also at high risk. Adults above 55 years and those with history of melanoma are prone to nodular melanoma.

If any of you could find any changes in skin color or any suspicious spots on your skin, it should be consulted with your doctor without delay. Your doctor would observe it and if necessary do a biopsy to check whether it is melanoma/skin cancer or not. Nodular melanoma is a potentially serious skin cancer and if diagnosed early, can be cured. It can progress deep inside your skin affecting vital organs and nearby lymph nodes. Over weeks, the lesion which you observed as small mole can grow into large sized lump rapidly spreading inside the nodes. Hence it is better to prevent skin cancer than to treat it.

Symptoms Of Nodular Melanoma :

Nodular melanoma appears in the form of suspicious spots on the skin. It can occur anywhere in the body but largely found in the neck portion. Often the spots do not change into cancer-causing cells (malignant) but if they change in color or grow in size it can be malignant. You need to know about the ABCD rule when diagnosing melanoma. ABCD is the short form of Asymmetric, without any defined Border, Color change and growing Diameter size.

• Asymmetry :

If you are drawing imaginary line through the middle of spot or mole, you will not get 2 equal halves, which is known as asymmetric in nature. If the moles are cancerous, it will not have a defined shape.

• Border (without) :

Melanoma of any type will not have a defined border. Normally moles have a clear border but melanoma borders are uneven and irregular.

• Color (change) :

Melanoma can be distinguished by moles easily. Normal moles will be often black or brownish in color. In the case of melanoma the color would be changing or have mix of colors. Moles that have different range of colors in them are malignant. In some cases the color would be changing from black to brown or red and sometimes you can find even white color. This type of color changing is a clear sign of malignancy.

• Diameter :

Normal moles are smaller in size and they do not grow. But melanomas grow in size and it measures roughly 6mm in diameter or even more. It may look smaller when you first noticed it but gradually over weeks it grows in size.

• Evolving :

Melanoma.org (Melanoma Research Foundation) has added a new letter “E” meaning evolving. Unlike benign moles, melanomas are evolving (changing in nature). Anything that changes in color, shape, size and border are definitely a matter of concern. You should be alert while examining your body from head to toe if you see any new development of moles which are evolving in nature.

Other symptoms of nodular melanoma include shiny bumps, dark colored lesions, and lumps that do not heal. Any changes in existing moles can be cancerous. Moles that are bigger than pencil eraser in size can be melanoma. Melanoma can occur anywhere but often it can be seen on the chest, back, hands and soles. In rare cases it can occur in your mouth or even anus.

Nodular Melanoma Causes :

When the pigment cells called melanocytes undergo repeated fusion it becomes malignant and is found on the basal layer of the epidermis. Series of changes can happen in the DNA molecules causing melanoma. Repeated sun exposure and increasing number of moles can cause skin cancer of any type.

Diagnosis :

It is wise to do self-body examination once in a month if you are above 45 years or if you are a person with large number of moles. If you have any doubts about the increasing size of a mole or changing and evolving mole you need to consult your doctor promptly. Your dermatologist or doctor would clearly examine the body and may order for biopsy. A small tissue sample of the mole is taken and tested in the laboratory to detect presence of cancerous cells. Microscopic test is done to detect Clark level of invasion and also to find Breslow thickness. Some doctors use mitotic rate to check how fast the malignant cells are growing. Some of the tests used for diagnosing nodular melanoma are dermoscopy to identify melanocytic naevi and pigmented carcinoma cells.

Nodular Melanoma Treatment :

The method of treatment of nodular melanoma differs on factors like your age, size, color and shape of the mole or lumps and how far the melanocytes have proliferated. Surgical excision is the first line treatment for nodular melanoma. The area in and around the skin where lumps are located are surgically removed. It can be done at the doctor’s office under local anesthesia.

In case the malignant cells have spread deep inside the skin and invaded the nearby lymph nodes then it has be removed completely by surgery. Chemotherapy and other radiation methods are not usually considered for melanoma. However in some cases it has to be supplemented if required. Medications are prescribed in the form of injection or oral pills.

Tips For Prevention :

• You cannot prevent certain factors like parental history of nodular melanoma. But you can always do self examination and consult your dermatologist at regular intervals if you have large number of moles in your body.


• To the extent possible, limit the exposure to the sun.


• Consult your doctor promptly if you observe some changes or have some doubts regarding the growing moles.


• Follow ups and body examination by your doctor is absolutely necessary to prevent recurrences.

Outlook :

• Nodular melanoma is a potentially serious type of cancer occurring in the skin. Prognosis and survival rates depend on how far the disease has progressed.


• Early the intervention the greater would be the recovery and vice versa.


• People with previous history of melanoma are at high risk of relapse.


• People with stage 1 or localized melanoma 5 year survival is guaranteed. For those with thicker sized melanomas about 80% of the people can live up to 5 years. And for nodal metastasis and distant metastasis chances of 5 year survival is about 10-25%.

Acral Lentiginous Melanoma – Causes, Symptoms, Treatment

Acral Lentiginous Melanoma – Causes, Symptoms, Treatment






Acral lentiginous melanoma or ALM is a type of skin Cancer. It is often misjudged and goes unnoticed until the cancer cells have progressed. ALM develops on the hands (palms) and soles of your feet. About 1-3% of the people detected with melanoma develop ALM. This type of Skin Cancer targets white complexioned people and black-skinned people equally. Again like many other cancers, it is difficult to diagnose ALM. Treatment is by surgical excision of the lumps and sometimes other methods are also used. Prognosis and survival depends on the extent of progress of the disease. ALM can occur on the normal skin and also on the existing mole.

ALM starts slowly as a flat patch on the skin or on the mole. Initially malignant (cancerous) cells remain restricted with the tissue or epidermis. It can be in-situ for weeks together or even months. But gradually the melanoma cells spread deep into the skin invading other areas nearby and even the lymph nodes.

Who Are At Risk ?

ALM is a rare type of skin cancer and it has no bar against color of the skin. It targets white and dark skinned people equally and sometimes black skinned people are at high risk. ALM occurs equally in men and women and adults above 45 years are the target.

Causes :

Exact cause of the occurrence of ALM is not known. Repeated mutation of DNA is known to cause melanoma. Progressive sun exposure can intensify formation of moles and sunburn.

Symptoms :

ALM occurs as red or brownish pigment on the skin and often it occurs on the palms of your hands or soles of the feet. It occurs largely on the extremities of the body. Acral lentiginous melanoma initially appears as a stain on the skin color and gradually increases in size and shape. ALM moles are asymmetric in shape, without defined border and it is changing in color and the diameter of mole is roughly the size of pencil eraser.

The size of melanoma can range above 6 mm in diameter and is often seen in mixed color or varying colors like bluish grey, brownish blue and reddish brown etc. It resembles ulcer or big bumps on the skin and may sometimes bleed. The Tumor like cells is thick in pigment and grows in size on time.

Tests :

The cells of melanoma of ALM go unnoticed until it becomes bigger in size. Dermatologist can detect cancer during examination. Biopsy is done to confirm the analysis. A tissue sample from the mole is taken and tested under a microscope. It shows positive report for BRAAFF test and if closely observed, melanoma can be detected by ABCDE rule. Once the cancerous cells starts metastasizing it becomes difficult to treat and fully cure ALM like many other cancers. Complete recovery is possible during the initial stages.

Staging :

Breslow thickness and Clark level of invasion rating is used for determining the stage of melanoma.

• In level 1, melanoma is in-situ (in the same location)


• In Level 2, the cancer cells would have occupied papillary dermis. In the next level of 3, the cells would have invaded reticular dermis and in the level 4 and 5, it would have spread to subcutaneous tissue and nearby lymph nodes.

Treatment :

It is better to prevent melanoma than to treat it.

In the phase 1 and 2 when the moles are thin it can be surgically excised and removed. Follow up is to be done at regular intervals to check that the cancer cells are not growing again.

When it comes to stage 3 or 4, treatment is difficult. Cancer cells would have spread to nearby lymph nodes and even to other organs.

Surgery is done for removing the nodes that are involved causing more complications.

Minor amputation of the nail and soles are done for subungual lesions. The surgeon would try his best to save the ball of the foot. The entire (affected) finger or toes is removed along with lymph nodes to increase the survival rate.

Laser and cryo therapy is done for ALM. Additionally topical steroids are also given. Removal of nodes is considered only if the cancer cells have metastasized and spread to other organs.

Other forms like chemo and radiation are to be done in severe cases. Immunotherapy and target therapy are some kinds of treatment for ALM.

Self skin examination and routine checkups are to be done for monitoring the condition of the patient after surgery.

Rate Of Survival :

Stage and extent of cancer decides the rate of survival in any type of cancer. Prognosis is good if the cancer is detected early and treated soon. Depth of the tumor and extent of spreading can reduce the survival rate.

Melanoma

Melanoma






It is a type of Skin Cancer costing your life. Among all other types of skin cancer, melanoma is potentially harmful. It can affect any part of the body causing serious consequences. Four types of melanoma are available. The first one is superficial melanoma is commonly found in many people and occurs as small black dots on the skin. Next is Nodular melanoma which appears as separately raised spots and is blue or dark black in color. The third type is Lentigo maligna melanoma which occurs only on aged people and is seen on face, arms and neck area where sun’s exposure is at its maximum. The last type is Acral lentiginous melanoma which is seen in palms, soles and nails.

In rare cases, melanoma develops on the eyes and even on retina. It can also develop in anus, vagina and urinary tract. It is truly serious to know that melanoma is steadily increasing nowadays and it attacks even young people.

Causes :

Melanin is the skin pigment produced from our cells by name melanocytes. This pigment is the factor that determines the color of your skin. When these melanocytes undergo certain changes, it causes special type of skin lesions called melanoma (causing cancer).

Who is at risk to get melanoma ?

People with fair complexion, bluish green eyes, and blond hair are prone to get melanoma. The individuals who live in warm regions or on high altitudes, and who is largely exposed to sunlight at workplace are at risk. If you have at least one episode of sunburns in your life, you certainly have increase chance for getting melanoma.

Genetics also play a role in melanoma and it can be passed on to next generations through chromosomes. For people who have chronic disorders like AIDS or cancer and people with lowered immunity level are also at risk.

Symptoms :

Melanoma looks very much like a mole. It may be in the form of extended lesions or bumps on the skin surface which changes color. Very often they are of irregular shape and their borders are different. You can remember the famous ABCDE mode for detecting the presence of melanoma. You need to make regular visits with your dermatologist for early detection of melanoma.

Diagnoses :

Your doctor will examine the shape, size, color and texture of the moles for detecting any suspicious moles. Skin biopsy is done for confirming the illness. In case the result is positive, then CT scan is to be done for examining how far the cancer has spread.

Treatment :

Surgery is made for removing cancerous skin layers, tissues and even lymph nodes. Chemotherapy is given for killing cancerous cells; immunotherapy will increase the immunity level to fight against cancer. Radiation methods and surgery is also combined for some people to destroying cancer causing cells.

Prognosis :

Melanoma can become serious if not detected in early stage. It cannot be cured if the cancer has spread into the nearby lymph nodes.

Pictures of Melanoma :

Images, Pics, Pictures and Photos of Melanoma

Prevention :

You can reduce the chance of getting melanoma if you reduce the exposure to sunlight. Avoid going out in hot sunny climate. Apply sunscreen lotion liberally if you need to go out in hot sun. Avoid doing tanning in salons.