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Dermatology Center for Skin Health, PLLC Blog

Subungual Melanoma: Warning Signs of Melanoma Under and Around the Nails

[fa icon="calendar"] May 4, 2022 4:53:17 PM / by Dermatology Center for Skin Health, PLLC

Dermatology Center for Skin Health, PLLC

Melanoma is the most dangerous form of skin cancer because it can spread from the skin to other areas of the body. While it is most commonly detected on the skin, melanoma can also develop around and under the fingernails and toenails in rarer cases. When this occurs, it is referred to as subungual melanoma. The good news is that if it's detected early, subungual melanoma is highly treatable. Continue reading to learn more about subungual melanoma.


Subungual melanoma is a type of melanoma that develops in the skin under the nails. Dermatologists generally discover subungual melanoma on the pollex (thumb) or hallux (big toe), but it can occur in any of the fingernails or toenails. 

This type of melanoma is rare, affecting 0.7 percent to 3.5 percent of patients with melanoma. However, like other types of melanoma, subungual melanoma is deadly and can spread to other body parts if left untreated.


Melanoma is often associated with sun damage and moles or spots that look similar to a mole. However, subungual melanomas are not associated with sun damage. Instead, this form of melanoma usually appears as black or brown streaks in the nail bed, while more streaks can appear in different colors as the cancer progresses. 

Some common warning signs of subungual melanomas include: 

  • Vertical light to dark brown colored nail band
  • Dark nail band that gradually expands
  • Dark skin next to the nail
  • Nodule underneath the nail 
  • Nail brittleness and cracking
  • Bleeding 


The cause of subungual melanoma remains unknown. However, there are risks associated with its development; these increased risk factors include: 

  • Having nail trauma
  • A medical or family history of melanoma
  • Being between 50 and 70 years of age and African, Asian, or Native American in origin
  • Having multiple moles
  • Having a condition that causes a weakened immune system, including patients with HIV and organ recipients 
  • Genetics, including those with the xeroderma pigmentosa (a hereditary condition that causes extreme sensitivity to ultraviolet light)


Subungual melanoma is difficult to detect without a trained eye, and patients often mistake it for nail fungus. Therefore, if you notice any changes or growths on your nails, immediately schedule an appointment with a dermatologist. 

The only definitive way to diagnose subungual melanoma is with a biopsy. Typically, a dermatologist will perform an excisional biopsy (the lesion and some surrounding tissue are removed) or a punch biopsy (a small circular sample is removed). The providers at the Dermatology Center for Skin Health, PLLC, send all samples to a certified dermatopathologist who specializes in reading skin specimens specifically.


Treatment for subungual melanoma has evolved in recent years. In the past, dermatologists preferred amputation, but depending on how early it's caught, dermatologists can use a more conservative approach, like removing the nail, today. 

Treatment options for subungual melanoma can include: 

Remove the entire nail and growth (common)

  • Amputation (severe cases)
  • Radiotherapy 
  • Immunotherapy
  • Chemotherapy
  • Targeted therapies

Response to treatment will vary based on the stage of cancer. With early treatment, the outlook is positive. However, the survival rate grows poorer for patients who delay seeking diagnosis and treatment. That's why it's crucial to inspect your skin and nails for any changes and visit your dermatologist regularly. 


Warning signs of subungual melanoma are challenging to catch without the help of a trained dermatologist. Our providers at the Dermatology Center for Skin Health, PLLC, in Morgantown, West Virginia, have 28+ years of medical experience, including diagnosing and treating different types of melanoma. If you have any questions about subungual melanoma or need to schedule an annual skin check, please call us today at (304) 598-3888.


Book An Appointment Today! 



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Topics: melanoma

Dermatology Center for Skin Health, PLLC

Written by Dermatology Center for Skin Health, PLLC

Our priority is to deliver complete, compassionate care to our patients while educating and assisting them as they make care decisions regarding the health and beauty of their skin.