The Silent Skin Cancer: Subungual Tumors

photo courtesy of New England Journal of Medicine

My patients are always surprised when I check their fingernails and toenails for skin cancer. “Doc, you can even get skin cancers under your nails?” is the typical question. Indeed, although rare, it is possible to get skin cancers, and even deadly forms of melanoma under the nail.

 Skin cancer under the nail may begin in many ways:

  1. A thin brown line that gets darker and thicker over time: this may indicate a melanoma, and requires immediate attention. Your dermatologist may evaluate for Hutchinson’s sign:  this is pigmentation in the cuticle, the nail fold (the skin on the sides of the nail), or even the lunula (half-moon at the base of the nail). If Hutchinson’s sign is present, a biopsy should be performed urgently.   Continue reading

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