People of color are at higher risk  for melanoma (skin cancer) in their fingernails.

Melanoma can arise in the fingernail, or nail bed, and is called acral lentiginous melanoma. Below is a photo of what this may look like.

“The patient is a 42 year old black male with pigmentation of the thumb nail,” says Gary Goldenberg, MD, of Goldenberg Dermatology, and assistant professor of dermatology and pathology at Mount Sinai School of Medicine.

“The patient thought that the lesion was caused by trauma and ignored it for over one year.

“The patient presented due to increased pigmentation and pain when using the thumb to perform simple tasks.

“A biopsy was performed and showed a deep acral lentiginous melanoma.

“The patient, unfortunately, required thumb amputation and subsequent chemotherapy.”

Acral lentiginous melanoma is so rare (even in blacks) that most dermatologists won’t encounter it in their professional career.

Melanoma in a nail (which includes toes) may be misdiagnosed as a bruise, fungus or birthmark, and black patients may think it’s benign simply because of their skin tone.

However, a birthmark would have been there since childhood. A fungus will respond to medication, and a bruise will eventually go away when the offender (such as a tight shoe or high heels that compress the toes) is removed.

Beware: Acral lentiginous melanoma can resemble a harmless bruise.

With a bruise that’s underneath the nail, the rest of the finger (or toe) will be normal.

Often, with nail melanoma, it spreads to the cuticle or skin around the nail or behind, and the initial discoloration also spreads.

Acral lentiginous melanoma may also take a straight line shape from nail bed to tip of nail.

It’s normal to develop dark brown or black “streaks” or “slivers” in the nail. In the case of ALM, it’s thick (does not look like a “sliver”) and looks more like a band.

Blacks not Immune

Do NOT avoid getting a biopsy just because you think you’ve convinced yourself that the new symptom is just a bruise or benign streaks or slivers.

Blacks (plus other dark skinned individuals and Asians) are more likely to develop melanoma in the nails than are whites.

Don’t wait; have a dermatologist take a biopsy to rule out anything serious. Chances are it’s benign, but why take chances?

Top image: Courtesy of Dr. Gary Goldenberg

Dr. Goldenberg of Goldenberg Dermatology provides comprehensive care in medical and cosmetic dermatology, including melanoma and other skin cancer, moles, psoriasis, eczema and acne. He is the medical director of the Dermatology Faculty Practice, NY.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.