Toenail Bruising: Is It a Sign of Melanoma?

Nail hematoma

Hello, Director: About a month ago, I noticed a small brownish area on the nail of my right middle toe that resembles a bruise.
There is no pain when I press on that area, but the nail has been growing very slowly during this time.
I usually wear flip-flops, and I am concerned whether this could be a type of melanoma.

KENKEN, 40~49 year old female. Ask Date: 2022/02/15

Dr. Wu Yuxin reply Dermatology

No lesions were observed, making it difficult to determine the issue.
If this is causing significant distress, please seek medical attention promptly.

Reply Date: 2022/02/15

More Info

Toenail bruising, particularly when it presents as a dark spot or discoloration under the nail, can indeed raise concerns about potential underlying conditions, including melanoma. However, it's essential to understand the context and characteristics of the discoloration to assess the risk accurately.

In your case, the presence of a small brownish area under the toenail that resembles a bruise but does not cause pain is noteworthy. Melanoma, a type of skin cancer that can occur under the nail (known as subungual melanoma), typically presents as a dark streak or spot that may gradually enlarge or change in appearance. Other signs of melanoma can include irregular borders, asymmetry, and variations in color. However, not all discolorations under the nail are indicative of melanoma.

Common causes of toenail discoloration include:
1. Trauma or Injury: A bruise under the nail can result from minor trauma, even if you do not recall a specific incident. This is often the most common cause of such discoloration and usually resolves over time as the nail grows out.

2. Fungal Infections: Fungal infections can lead to discoloration and thickening of the nail, which may sometimes be mistaken for bruising.

3. Benign Pigmented Lesions: These are non-cancerous growths that can appear under the nail and may be mistaken for melanoma.

4. Melanoma: As mentioned, while it is a possibility, it is less common than other causes. Subungual melanoma can occur, particularly in individuals with risk factors such as a history of skin cancer, fair skin, or a family history of melanoma.

Given that the discoloration is not painful and has been present for about a month, it is crucial to monitor it for any changes. If the spot enlarges, changes in color, or if you notice any other concerning symptoms (such as pain, swelling, or changes in the nail structure), it would be advisable to seek evaluation by a dermatologist. They may perform a thorough examination and, if necessary, a biopsy to rule out melanoma or other serious conditions.

In summary, while toenail bruising can be a sign of melanoma, it is essential to consider other more common causes. Regular monitoring and consultation with a healthcare professional can provide peace of mind and ensure that any potential issues are addressed promptly. If you have any further concerns or if the discoloration changes, do not hesitate to seek medical advice. Early detection and intervention are key in managing any potential health issues effectively.

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