Melanoma Under Toenail, Fingernail, on Toe, on Finger: Symptoms, Treatments

The fact that melanoma is one of the types of skin cancer is widely known. What most people may not know is that the disease develops in cells known as melanocytes. These are the same cells that produce melanin, the substance that gives color to hair, skin and eyes. Large concentrations of these cells are to be found on the skin while smaller concentrations are contained in mucosal membranes and the uveal tract of the eye.

Most melanomas begin on the head and neck areas, legs, trunk, and arms. They however can begin in fingers and toes. Once tumors have spread, many complications arise. This is best seen in choroidal melanoma prognosis. See what is metastatic melanoma for more details.

Melanoma under toenail symptoms, causes and treatments

Melanoma under the toenail often develops in the big toe. It can arise in the nail matrix, under the nail plate or in the skin that borders the nail plate. The disease may begin with a streak or a fleshly nodule. The latter is more dangerous and requires immediate nodular melanoma treatment.


In most cases, symptoms will revolve around changes in a streak that develops vertically from nail bed to the tip. With time, the streak will widen at the base, spread to the nail fold and develop multiple colors. In some cases, there will be ulceration and cracking of the affected nail.

Some melanomas under the toenail largely lack pigmentation. For this reason they appear fleshy or reddish. While a streak that resembles a blemish under the toenail is the most common early sign, some people will develop a flesh-colored or red nodule in the skin bordering the toenail. This can be mistaken for a blood blister or a hematoma. The main difference is that the nodule will not be painful at first and will persist indefinitely.


Exact causes of melanoma under toenail are not clearly understood. This is especially due to the fact that this type of melanoma is not associated with UV radiation. Risk factors may include:

  • Dark skin
  • Age
  • Toe injuries
  • Weakened immunity

Diagnosis and treatment

Diagnosis is very essential to rule out other possible causes of blemishes and spots under toenail such as fungal infections. During diagnosis, a doctor will carry out a physical examination. The patient will be required to provide brief details of their symptoms and medical history. Biopsy will finally be taken to confirm diagnosis.

Treatment is primarily done with excision melanoma surgery. This involves cutting out the tumor and some of the surrounding tissue. Depending on the stage the tumor is in, more treatment options such as chemotherapy and radiotherapy may also be used. See full malignant melanoma definition to understand how tumors spread.

Melanoma on toe symptoms, causes and treatments

Melanoma on the toe can begin on the upper part or the bottom. While the disease is rare, most people tend to ignore its early signs. Another problematic issue is the notion that melanomas will always be brown or black. It is a common factor that worsens spitzoid melanoma prognosis.


When it occurs on the upper side of the toe, the melanoma will most likely resemble a mole, a discolored spot or a wart. If it develops on the bottom side, it may resemble a blood blister or a dark-brown patch or spot.

The best way to identify early warning signs is using the ABCDEs. Start by checking whether the spot can be divided in two equal halves. After that, see if the points at which discoloration ends follows a consistent pattern, such as to make a round or oval shape. Proceed by determining the primary color of the spot. Lastly, compare the current status of the spot with how it appeared some time before.

Generally, normal moles or spots should not change, especially over a short timeline. They also should not have multiple colors.


Melanoma on the upper side of the toe is thought to be encouraged by exposure to direct sunlight or other sources of UV radiation. There also are reasons to associate it with injuries and forms of trauma. People with fair skin or have many atypical moles are also at a higher risk.

Melanomas that occur on the bottom side of the toe are also thought to be encouraged by the above mentioned factors.

Diagnosis and treatments

The ABCDEs alone cannot be used to confirm diagnosis. Doctors usually use dermoscopy to check the behavior of cells in areas with melanoma signs. For more accurate results, a biopsy will be taken.

Treatment depends on how advanced the melanoma on toe is. It is also much the same with other melanoma types, a reason as to why uveal melanoma staging is quite complex. A skilled plastic surgeon can remove an in situ in a not too complicated surgery. If malignancy has spread to lymph nodes, surgery will also be needed to remove the affected nodes. This also goes for tumors that have spread to organs such as the lungs. Advanced melanomas also require treatment alternatives such as chemotherapy and radiotherapy. See malignant melanoma definition to understand how the disease spreads.

Melanoma under fingernail symptoms, causes and symptoms

Melanoma under the fingernail falls in the subtype referred to as subungual melanoma. It is not common but unfortunately is  often misdiagnosed.

The common early sign is appearance of a dark line under the fingernail. The problem is that many other causes can be responsible for such a line. So how do you tell the difference between normal lines and malignant ones under fingernail?

First, you can use the Hutchinson’s sign. This is where the line or streak widens at the nail cuticle and spreads or causes color changes to the nail bed. Lines caused by melanoma also tend to widen, forming bands or streaks rather than lines.

Another way to tell if a streak is malignant or not is by associating it with recent cases of injury or trauma. For example, when a finger is trapped under a heavy object, one or several blood vessels may become damaged. As a result, blood will leak and collect under the fingernail. Other forms of trauma such as psoriasis may have similar results. The main difference between blemishes formed in this manner and malignant ones is that the former improve and disappear with time. Sometimes, the affected fingernail may come off during the healing process.

Diagnosis and treatment

A doctor will physically examine the affected finger for any signs of malignancy. For accuracy, a biopsy will be taken.

Treatment depends how invasive the melanoma has become, thickness of the tumor, its location among other factors. For example, large mucosal melanoma treatment may not be very successful with surgery unless the entire affected organ is removed.

Regardless, surgery will be the treatment option of choice. Small tumors respond very well to excisional surgery. For large tumors, amputation may be done at the joint closest to the fingernail.

Since early signs of melanomas under the fingernails are often ignored or misdiagnosed, the possibility of malignancy having spread to other body parts is always there. This calls for other treatment options such as chemotherapy, radiotherapy and targeted therapy.

Melanoma on finger symptoms, causes and treatments

Several types of melanoma can develop on the finger. The type will depend on which part of the finger it is appearing on. See acral lentiginous melanoma pictures for illustrations.

Superficial spreading melanoma often begins as a freckle which spreads across the skin. If not treated, it may penetrate deeper into the skin and spread. Nodular melanoma is another common type and most invasive. It often appears as a red nodule on the skin that rapidly gains mass. In people who have a history of sunburns or long periods of sun exposure especially during childhood, lentigo maligna melanoma may occur. Early signs of this melanoma resemble sun spots and may easily be ignored. The common sign is appearance of shades of black and brown.

Most melanomas on fingers develop on sun-damaged areas. People with fair skin or who have a history of sunburns are usually at a higher risk.

Diagnosis and treatments

Melanoma signs can help a lot with diagnosis. This can be achieved with the help of the ABCDEs and dermoscopy. Doctors however usually confirm diagnosis with a biopsy.

The mode of treatment to be adopted depends on factors such as location of the tumor, thickness of the tumor, age and health status. The much tumors have spread or basically subungual melanoma stages will also largely determine treatment procedures.

  • Stage 1 –stage 1 tumors have not left the finger. These ones can be removed by a plastic surgeon with excision surgery.
  • Stage 2 – stage 2 finger melanomas have still not spread but have penetrated into the dermis. Further, the tumors will reach blood and lymphatic vessels. It is common for stage 2 melanomas to bleed, a factor that increases the chances of spreading. Surgery is still the main method of treatment. If necessary, a part of or the entire finger may be amputated. Radiotherapy and chemotherapy may also be used.
  • Stage 3 – some malignant cells have left the primary tumor on finger and entered the lymphatic system. It is likely that local lymph nodes in armpit have swollen. Surgery is done to remove the primary tumor and invaded lymph nodes. To ensure complete removal of all malignant cells, other treatments such as chemotherapy, targeted therapy and immunotherapy may be used.
  • Stage 4 – tumors are so advanced that they may have spread to the brain, lungs, nodes and other organs. It is usually not possible to cure melanoma at this stage. However, drugs and surgical tumor removal can be used to prolong lifetime. These same treatment procedures are applicable for melanoma on back.


The perhaps best and most basic prevention measure against melanoma is learning the much there is to know about the disease. You can start with types, symptoms and common causes of the disease. Topics such as how fast does melanoma grow or eye melanoma may also help.