Dark Pigmentation on Toes: Causes and Concerns

Melanin deposition at the tip of the toes?

Hello, Dr.
Wu.
I would like to ask about a long, black stripe I suddenly noticed at the tip of my toe.
It is not painful, does not protrude, and seems to be beneath the epidermis.
When I used nail clippers to examine it, I found that it could be scraped off, resulting in slight bleeding, but a small black dot remains that cannot be removed.
I am very concerned that it might be a concerning melanocytic lesion.
What should I do for further evaluation and management?
Additionally, I would like to inquire about a flat black mole that appeared the day after tomorrow.
Its fading color—what does that signify? Should I be worried about any potential issues? Thank you for your guidance on these matters!

ALZ, 20~29 year old female. Ask Date: 2016/03/20

Dr. Wu Yuxin reply Dermatology

If the lesion cannot be confirmed without direct observation, it is advisable to seek medical attention as soon as possible if it is causing significant concern.

Reply Date: 2016/03/20

More Info

Hello! It sounds like you're experiencing some concerning symptoms with the dark pigmentation on your toes. Let's break down your situation and provide some insights into potential causes and appropriate actions.

The appearance of a dark stripe or spot under the toenail or on the toe itself can be attributed to several factors. One of the most common causes is a benign condition known as a subungual hematoma, which occurs when blood collects under the nail due to trauma. This can happen even if you don't recall a specific injury. The dark color is typically due to the presence of blood, and while it may not be painful, it can be alarming to see.

Another possibility is a benign pigmented lesion, such as a melanonychia, which is a brown or black stripe that can appear on the nail due to increased melanin production. This can be caused by various factors, including genetics, certain medications, or underlying skin conditions. However, it’s essential to differentiate between benign conditions and more serious concerns, such as melanoma, a type of skin cancer that can manifest as a dark spot or streak under the nail.

Given that you mentioned the ability to "dig" at the dark spot and see some bleeding, it’s crucial to approach this with caution. While minor bleeding can occur from superficial trauma, any persistent or changing pigmentation should be evaluated by a healthcare professional. A dermatologist can perform a thorough examination and may recommend a biopsy if there is any suspicion of malignancy.

Regarding the appearance of a flat black mole (nevus) that has developed recently, it’s important to monitor its characteristics. Changes in size, shape, color, or texture of moles can be concerning and may warrant further investigation. The "ABCDE" rule is a helpful guideline for assessing moles:
- Asymmetry: One half does not match the other.

- Border: Edges are irregular, ragged, or blurred.

- Color: The color is not uniform and may include shades of brown, black, or even red, white, or blue.

- Diameter: The mole is larger than 6mm (about the size of a pencil eraser).

- Evolving: The mole is changing in size, shape, or color.

If your new mole fits any of these criteria, or if you have any concerns about its appearance, it is advisable to seek a professional evaluation.

In terms of next steps, I recommend scheduling an appointment with a dermatologist as soon as possible. They can provide a comprehensive assessment of your symptoms, perform any necessary tests, and discuss treatment options if needed. Early detection is key in managing any potential skin issues, especially when it comes to pigmented lesions.

In the meantime, avoid picking at the area, as this can lead to infection or further irritation. Keep the area clean and dry, and consider covering it with a bandage if it is sensitive or prone to further injury.

Lastly, it’s understandable to feel anxious about these changes in your skin. Remember that many skin conditions are benign and treatable, but it’s always best to err on the side of caution and consult with a healthcare professional for peace of mind and appropriate care. Take care, and I hope you find the answers and relief you need soon!

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