Saturday, February 11, 2012

Amelanotic Melanoma and Subungual Melanoma

When we talk about melanoma, most people picture an irregular, dark, large mole that has changed over time, and indeed, these characteristics are often symptoms of melanoma. Today I want to talk about two variants of melanoma that are harder to diagnose than those mentioned above. A melanoma tha...
12/ 4/07 8:12pm

Thanks Doctor Berman for this important information.

 

Please read more in our Skin Cancer Basics as well as finding out more about you own possible condition  in Check a Symptom.

 

 

All the Best, SMM 

Anonymous
Janice
2/29/08 9:46am

Dear Dr.

 

As a person who's had melanoma, basil cell and squamous cell skin cancers, I was happy to learn of the two variants of melanoma. Would it be possible to show pictures of these variant melanomas to help us identify them on ourselves?

Thank you

 

Janice

Chicago

Anonymous
Anonymous
1/12/10 1:52pm

Just google melanoma and thumb and there are lots of pictures

Anonymous
Tom Crais MD
2/25/09 6:02pm

Thanks for quick reference. Have seen both types of described melanoma, but have not seen nor heard of amelanotic subungual melanoma. Is there such an entity reported? What about widenening  decreasing demarcation of white subungual line?

Thanks

Tom C M.D.

Anonymous
Anonymous
11/10/09 5:57pm

Dear Dr. Tom,

I am a 52 year old white male. I had Amelanotic (No Pigment) Subungal Melanoma.

On April 29, 2009 I had my left thumb removed and, a toe to tumb transfer done at the Mayo Clinc in Rochester, MN by Dr. Allen Bishop. Hope this helps. 

Greg VN

 

Anonymous
Lisa
5/30/09 5:20pm

My name is Lisa. I am 35 years old. I was told when I was 10 years old, that I had skin cancer on my face. By the age of 15, I was told in was not cancer, but it was: (i will try to spell it right)

 

Trichoepothelioma......hair folical tumors which where caused from the mutation of the genes when I was conceived.  I would like to have a dermatologist from the University of Michigan take a look. I saw this on a special on Chicago's channel 7 special report on Saturday May 30th, at 4pm.

Anonymous
Anonymous
10/14/09 1:37am

I had this melanoma under my thumbnail.  The treatment was amputation of the first digit of the thumb.  I had the stripe you have defined for many years before a darker spot appeared and the cuticle discolored.  Fortunately there was no further finding of cancer in my sentinel node and the amputation went surprisingly well.  It is more an inconvenience to have this much of my thumb gone than a problem.  All I can say is pay attention and have it checked early.  I might have avoided amputation had I had it diagnosed properly earlier on. 

Anonymous
Anonymous
1/12/10 12:18pm

I am a 38 year old white female.  I had a longitudinal streak in my left thumb removed almost 3 years ago.  A hand surgeon did the surgery and my thumb and nail grew back remarkably well.  The pathology report showed the cells were benign.  However, about 6 months after the surgery the brown streak reappeared and is still there.  I am checked every 6 months by my dermatologist for any change.  I had an appt this morning and he's now growing more concerned that the streak appears to be changing a bit.  It's still measures just 1mm, is brown in color, but it looks like it may be a little darker and more blurred toward the end of my nail.  He took pictures today and wants me to go see my surgeon to have him look at it so he can be aware of what's going on.  My dermatologist is comfortable with seeing me again in 6 months but I just can't help thinking the worst.  I've debated about having the end of my thumb removed and after reading your post think this might be the best way to get rid of this once and for all.  I hate seeing it every day and it causes me a lot of stress.  I could live without the end of my thumb, but I don't want my children to live without their mother.

Anonymous
Anonymous
1/12/10 2:01pm

I imagine it would be stressful thinking about it all the time.  In a way, my decision was easier, because I really had no choice.  I had a plastic surgeon do the amputation, and I have been told it worked very well.  I did Physical Therapy for months afterwards, which I think really helped.  I only had to have the first digit (to the first knuckle) removed........so I do have a working thumb for most purposes.  However, it was my right thumb so when typing I now use my left thumb to hit the space bar because the right one is too short.  My right hand is stiffer and clumsier than it used to be.  But, I am a beader and a painter and I have been able to continue with both hobbies.  It is amazing how you adapt.  I am glad that I am retired because this may have been more difficult if I had still been working and typing at a keyboard all day.  I do not regret doing the amputation and mostly I just don't notice it.

I wish you luck and courage with your decision and I hope it turns out good for you. 

Anonymous
Anonymous
1/12/10 2:13pm

Thank you so much for your reply.  How long did you have the streak in your nail before it turned malignant?  I've been trying to find information on the progression of subungual melanoma but haven't found much.  My dermatologist has said that it's possible it could stay a benign nevis for the rest of my life, but there's this little voice inside of me (mother's intuition maybe?) that tells me it won't.  That's why I'm considering partial amputation.  I don't want to keep letting it go and have it progress to melanoma and then have to deal with amputation and the possibility that it has spread elsewhere.  (Subungual melanoma spreads very quickly and does not have a good prognosis once it has spread.  I'm happy to hear that you are healthy!)  I have an appt on Friday with my surgeon to see what he has to say.  I think at this point I will wait until July to see my dermatologist again and see if there has been any further change.  If there has, then I will need to make the decision between having the surgery I did 3 years ago or just going with amputation.

Anonymous
Anonymous
1/12/10 2:21pm

I don't really know.  I saw the stripe, but never had anyone look at it until I developed a large black spot under the nail and also the cuticle turned dark.  It was malignant when they did the biopsy and I only had one biopsy.  I am guessing, but I think the stripe was there for 5 or 6 years before I had anyone look at it.  Stupid huh?  Now I am checked every six months by my dermatologist for any recurrance anywhere on my body...........so I hope I stay clear.

Stay in touch I am interested to know how this goes for you. 

9/ 7/10 10:22pm

Hello!  I am a 41 year old white male.  I had a very similiar experience.  The brown line was in my right thumb nail for about 1 year.  This past Jan 2010, the nail started to crack and get darker.  I was lucky to have a family doctor who was familiar with this and referred me to a surgeon for a biopsy.  It was Malignant Melanoma.  On April 8th, 2010, I had part of my right thumb amputated (from first knuckle).

 

It certainly was very difficult at first both mentally and physically.  After several months, the healing has been great and much better than I expected.

 

After reading how deadly this could be, I am very content with the "cut to cure".

 

I wish you the best!

 

Schepers@lynden.com 

 

 

9/ 8/10 2:15pm

 

Hi, Michael!  Thanks for your response.  I'm happy to hear that your outcome was good and you are doing well!

 

How odd that you responded to my question yesterday.  Just a few days ago I was thinking about this thread and wanted to post something but I couldn't remember where it was.  (I forgot to save it in my Favorites.)  Anyway, I actually had an appt yesterday to have my thumb looked at again.  The last time I posted on this thread was back in January, right after I had seen my derm and right before I was to see my surgeon who removed the original streak.  My surgeon was kind of a jerk when I went to see him and acted as though my anxiety about this thing in my thumbnail was not founded.  He even said it was possible that the "discoloration" could be scarring from the surgery.  It's not scarring, it's another mole.  My dermatologist is confident of that.  My surgeon also thought it was ridiculous that I would even consider amputation.  Thanks.

 

Since then, I saw my derm in June and he believed everything to be stable.  Since that appt, I've noticed some change.  It looks like the streak is getting darker and there is a new, very faint streak right next to it.  I wasn't able to get right in to see my derm so I agreed to see another doctor in the same practice.  He took pictures and compared them to older pictures.  He agreed there has been some change, but feels strongly that it is not melanoma and is a "healthy mole."  I agree it's not melanoma right now, but I hate the fact that there is any change going on at all with this thing.  He was very reassuring that I'm fine, but there is the nagging feeling/inside voice that tells me this thing is up to no good and isn't going to stay benign.  I hate looking at this everyday and wish it could be gone for good.  He suggested that I see my derm again in 3 months, so I will be going back in December.

 

Was your streak brown in the beginning and then turn black?  Or was it black from the time it first made an appearance?  Also, how wide was it?  Did it widen over time?  The doctor yesterday told me that all the subungual melanomas that he has seen have all been black and wide and most had Hutchinson's sign (cuticle discoloration).  BTW...I've had junctional nevi removed from my thumb cuticle by my derm.  (Benign, but still mole cells on my cuticle.  Great.)  I guess what I'm wondering is if the mole in my nail matrix could turn malignant.  The doctor yesterday said it was good that it's been over 2 years since it reappeared and it still looks like it does.  But the fact that it's changing is what is concerning and very stressful for me.

 

Again, I appreciate your response!  Any more insight you may have would be wonderful.

 

Denise :)

9/ 8/10 2:19pm

Hi again!  Please see my update in a post below.

9/12/10 9:45pm

Hello Denise-

 

Mine started out as light brown line in the center of my right thumb nail.  It was there for about 7 months and I thought it was a bruise on my nail. 

 

Then all of sudden my nail started to ridge up in the center and then start cracking.  I thought at first I was just losing my nail and a new one would grow back.  The nail continued to get worse and then I started notice black streaks starting at the base of my nail.

 

At that point I knew it was time to go to the doctor only thinking it was a fungus.

 

I was very lucky my doctor had an idea what it may be and sent me for a biopsy.  It was discovered on March 13th and I had my surgery on April 8th.

 

Hope the above helps and certainly will be happy to talk to you more.

 

Send me an email at Schepers@lynden.com 

 

Thanks,

 

Michael

2/27/11 7:34pm

dear person you are lucky to have it when you are older than me. but i was born with this cancer and it took about a year to have found out that there is a doctor in NEW YORK CITY that gave me my life but told my strait up that i was going to die in matter of weeks so it was a week later i had my surgery and i was fine and now when i hert my hands all of the doctors called and asked how i was doing and how is life doing and we would say fineCool and now i feel safe but i have been having problems with my hand numing up after doing nothing and or waving to someone. so over all life is better. when i am at school my friend kiya says she is always happy that i am alive because she would have noone to talk to with her problems. so now i am happy someone knows what i have been through and noone at my school does i wish someone was there to show people what i have been through and the pain my family was in.

5/ 8/10 3:40am

 The contemplation was that individuals using sunscreens remained outdoors for more time thus soaking greater amounts of UVA which caused a greater melanoma risk.  Cause of melanoma  Majority of the sunscreen brands lately obtainable safeguard from UVA. But, the rise in the occurrence of melanoma has been believed to be partially accountable to infancy UVA exposure when the sunscreens during that time offered only shielding from UVB. This was not likely given the new-fangled study outcomes.

11/20/10 3:32am

My mom is Korean, 53 years old. Two months ago, there was redness, swelling, and pain under the knuckle of her left pointer finger. We thought it was just arthritis due to age. But looking at her finger now, I just noticed that there were two grey-brown vertical lines in the fingernail, and the cuticle has slightly pulled away compared to her other fingernails.

 

She's been trying to self medicate by massage, taking green magma, eating more dairy products, and coconut milk. The swelling and pain has gone down considerably since that time.

 

She refuses to go to the doctor. What does it mean if there is swelling in addition to the dark lines? Will someone let me know? I'm kind of worried, she's REALLY stubborn about going to the doctor.

11/20/10 11:20am

Hi there

 

I would strongly recommend that your mom go see a doctor and now.  She really needs to get this checked out immediately.  It could be nothing but what if it isn't?  Will she go for a routine physical just to get the process started?  Could you show her this article in hopes that she will get this checked out?

 

I wish you the best of luck.  Let us know what happens.

3/25/11 3:32pm

My name is Darrel Mayes. I am 15 years old and i have a black line on my right thumb. At first i thought it was nothing i had this thing for about a year. no symptoms well not that i know of. i looked up online black line on thumb and came across a picture of a black line on my thumb just like mine. i looked at the web site and researched on it. the name was called subungual melanoma. it was talking about biopsy and removing the whole thumb. unfortanetlly i like my thumb. u really cant play the xbox 360 without a thumb or carry stuff that well. if there is anything i could do to cure this cancer while keeping my thumb i am forever in whos ever debt  

Anonymous
Anonymous
3/27/11 8:54pm

Darrell,

 

You need to go see a dermatologist to have your black streak checked out.  Are you white or African American?  Dark nail streaks are common (and most often normal) in African Americans and other dark-skinned people.  If you are white, then you definitely need to have the mole in your nail matrix removed.  Tell your mom/dad/guardian about this and get an appt with a dermatologist.

Ask a Question

Get answers from our experts and community members.

Btn_ask_question_med
View all questions (701) >