Nail melanoma accounts for approximately 4% of the total number of malignant neoplasms. Subungual melanoma of the thumb of the lower extremity develops more often. Melanoma under the nail (photos are in medical manuals) is characterized by darkening of the nail around the nail bed. Next, a malignant tumor appears, which begins to destroy the nail. Oncologists at the Yusupov Hospital diagnose the disease using modern research methods.
Doctors use the latest chemotherapy drugs to treat patients. At the initial stage of nail melanoma, economical operations are performed. In case of relapse of the disease, radical surgery is performed and a course of chemotherapy is prescribed. Severe cases of subungual melanoma are discussed at a meeting of the Expert Council, where professors, doctors of the highest category, leading oncologists collectively develop further tactics for patient management.
Symptoms
The nail melanoma in the photo in the initial stage is similar to felon, paronychia or subungual hematoma. This makes its diagnosis difficult. Most patients who come to the oncology clinic have metastases. At an advanced stage, nail melanoma looks like a mushroom-shaped tumor with ulcerations. The tumor is dark red in color, with dark spots. In some cases, the neoplasm resembles granulation matter. The disease develops in different ways: slowly, with a predominance of metastasis through the lymphogenous route, or has an aggressive course with rapid dissemination of cancer cells. The nail melanoma in the photo (initial stage) has no symptoms. In appearance it may resemble a regular bruise.
The following symptoms are typical for subungual melanoma:
- The appearance of a characteristic dark or black spot on the nail, which grows very quickly and sometimes splits the nail in half;
- Darkening of the nail bed;
- Covering the entire nail plate with a cancerous tumor;
- The appearance on the nail plate of formations not only black, but also brown, blue, crimson;
- Bleeding when the nail plate is damaged.
Then the nail plate is undermined and destroyed due to the resulting ulcers. Purulent contents are released from under it. Melanoma under the big toenail may spread to the sole. This process leads to serious difficulties while walking. Sometimes the patient cannot stand on the affected lower limb at all.
What healthy toenails look like, photo
Indicators of toenail health:
- smooth, slightly convex surface;
- correct shape that follows the contours of the finger;
- absence of sagging, longitudinal and transverse grooves;
- absence of compacted areas, cracks and dents;
- smooth, not thickened, not flaking or crumbling edge;
- strong, dense, slightly pliable and elastic structure;
- uniform pale pink color without yellowness or bluish tint;
- absence of white, yellowish and dark spots under the nail plate.
Disease progression
In the initial stages, subungual melanoma has a limited size. Cancer cells have not yet affected other tissues and organs. The risk of further spread of the tumor process is low. If the tumor has not grown into the epithelial tissue, the person is diagnosed with stage zero melanoma. At the first stage of development of the pathological process, the thickness of the neoplasm does not exceed one millimeter. When the tumor thickness is up to 4 mm, the disease is at the second stage of development. At this stage there may be microscopic ulcerations. They are very dangerous: even one such cell located on a square millimeter can cause aggressive metastasis. At this stage of the disease, raised bumps may appear on the surface of the nail.
At the third stage of the tumor process, the thickness of the neoplasm exceeds 4 mm. Pathologically changed cells spread from the nail to the surrounding areas and lymph nodes that are nearby. Doctors at the Yusupov Hospital determine the presence of altered lymph nodes using a biopsy and histological examination.
At the fourth stage of development of the malignant process, melanoma cells begin to spread to other organs. Most often the liver, gastrointestinal tract, brain, and heart are affected. At this stage of the disease, the effectiveness of therapeutic measures does not exceed 10%.
With slow progression of melanoma, metastases appear at the most advanced stages. There is also a fulminant form of subungual melanoma, when metastases spread extremely quickly through the bloodstream to distant organs. The following signs indicate tumor metastasis:
- Change in skin tone (it becomes dull, ashy);
- The appearance of a noticeable compaction under the nail plate;
- The nail is almost completely destroyed and bleeds;
- Having a chronic cough;
- Increased body temperature;
- Development of seizures;
- Enlargement and hardening of lymph nodes;
- Loss of body weight.
Patients in the later stages of the tumor process develop cachexia. Patients in need of palliative care receive it at the Yusupov Hospital.
Crooked toenails, photos, causes, diagnosis, how to treat?
Toenails can become deformed - change shape and structure, become heterogeneous, become covered with grooves and wavy ridges, separate from the cuticle and curl - for a number of reasons.
Common causes of crooked toenails:
- hereditary predisposition;
- wearing uncomfortable shoes;
- metabolic or hormonal imbalance;
- deficiency of nutrients and vitamins;
- chronic diseases of the gastrointestinal tract and kidneys;
- injuries, inflammation and abscesses of the nails;
- complication of nail felon;
- consequences of long-term untreated onychomycosis.
To treat curvature of toenails, vitamins, mineral complexes, paraffin therapy, applications with ozokerite and healing mud, and physiotherapy are prescribed. In difficult cases, when crooked nails hurt, become inflamed, or interfere with walking, surgical correction is performed.
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Diagnostic methods
The diagnosis of subungual melanoma in the later stages is not difficult. Diagnosis at the initial stage, when there are no specific symptoms, is very difficult. Dermatologists at the Yusupov Hospital carry out differential diagnosis of subungual melanoma of the big toe with the following diseases:
- Panaritium;
- Fungal infection of the nail bed (onychomycosis);
- Wart;
- Subungual and subepidermal hematoma;
- Nevus;
- Cavernous thrombosed hemangioma.
The specific localization of the tumor process and its latency at the first stage make it difficult for the patient to visualize the tumor. Subungual melanoma is not visible in the photo at the beginning of the disease. Often the diagnosis is established already at the stage of vertical growth and the beginning of the spread of metastases.
Which doctor treats toenail fungus?
Onychomycosis of the feet - local or total fungal infection of the surface of the nail plates - is an infectious disease. It can be caused by several types of dermatophyte fungi: Trichophyton Rubrum, Trichophyton Interdigitale, Trichophyton Tonsurans, Microsporum Canis, etc.
A mycologist is involved in examining, identifying the causative agent of onychomycosis, as well as prescribing a course of antibacterial, anti-inflammatory treatment and restorative procedures .
Treatment
Today, for patients with early-stage subungual melanoma on a toe or hand, the gold standard is radical removal of the primary tumor with sentinel lymph node biopsy. In advanced stages of the disease, radical surgery does not significantly improve survival rates.
After surgery, oncologists prescribe the following treatment:
- Potent antitumor drugs;
- Irradiation of the affected area;
- Immunomodulatory drugs that enhance the body's defense reactions.
The prognosis mainly depends on early diagnosis, the radicality of surgical treatment and the timeliness of drug therapy. At the first stage, the five-year survival rate is 74%, at the second - 40%.
Effective ointments and varnishes against fungus
In combination with hardware procedures and antifungal medications, varnishes and ointments are used in the treatment and prevention of relapses of onychomycosis.
The action of varnishes is based on the destruction and sterilization of fungal spores, depriving them of their ability to reproduce, creating a dense, airtight coating on the surface of the nail plate, and preventing the spread of infection to healthy nails.
Seven effective medicinal varnishes for onychomycosis of the legs:
- "Loceryl";
- "Oflomil";
- "Batrafen";
- "Mikozan";
- "Lamisil";
- "Demicten";
- "Oflomelid."
Antifungal ointments contain antimycotics, anti-inflammatory substances that promote nail regeneration. Thanks to their thick and viscous consistency, they provide a long-lasting, effective and gentle effect only on the affected areas of the toenails.
Seven commonly recommended antifungal ointments:
- "Lamisil"
- "Terbizin";
- "Lamicon";
- "Mikomax";
- "Exoderil";
- "Atifin";
- "Terbinox".
Acral lentiginous melanoma
Acral-lentiginous melanoma is one of the varieties of clinical and morphological types of melanoma. It occurs on the skin of the fingers, interdigital spaces, soles, palms, and nail beds. The tumor is characterized by certain clinical features that differ from skin melanoma of other clinical and morphological forms.
In Latin Americans, people of the Mongoloid and Negroid races, this form of malignant tumor occurs in at least 50% of all patients with skin melanoma. The disease is diagnosed in older people and is characterized by a steady increase in the number of cases. The most common form of acral-lentiginous melanoma in whites is subungual melanoma. In this form of melanoma, unlike other malignant skin tumors, the main factors provoking its development are not sun exposure, but various types of chronic irritations:
- Frostbite;
- Performing cosmetic procedures for nail diseases;
- Temperature or mechanical injuries of the distal phalanges of the fingers.
The paucity of clinical manifestations of subungual melanoma, as seen in the photo, especially in the early stages of tumor development, the lack of a diagnostic algorithm and a clear description of the clinical picture, the scope of surgical treatment and prognostic factors for this form of melanoma necessitate early contact with doctors in the presence of a tumor on the finger or legs
Changes in Toenails – Should You Worry?
Yes, any, even not very noticeable, changes in nails are undoubtedly a cause for concern and an urgent visit to the doctor. Firstly, they may indicate metabolic disorders, hormonal imbalance, lack of microelements important for the body, and serious internal diseases. Secondly, infectious (fungal and bacterial) nail infections are contagious and can also spread into the deep layers of soft and bone tissue. Thirdly, nails that are yellowed, peeling, covered with grooves or dense sagging look unsightly.
Mycologists examine and treat patients with infectious diseases of the toenails. Non-infectious diseases of the toenails are treated by dermatologists and, if necessary, surgeons.
Prevention
Melanoma under the fingernail is difficult to detect and treat, but it is very easy to prevent. To prevent melanoma from developing, you should follow these recommendations:
- Persons with pale skin should strictly limit their time in the sun, especially in the spring and summer during peak solar activity;
- If a nail is damaged, consult a doctor immediately;
- If “paronychia” does not heal, immediately make an appointment with an oncologist;
- Limit bad habits - smoking and drinking alcohol, which reduce the severity of antitumor immunity;
- Always pay attention to suspicious changes in the nail plate.
Subungual melanoma does not always have a poor prognosis. In the early stages of tumor formation, it is curable. If you consult a doctor in a timely manner, the disease can be cured even if it recurs. For this reason, if you suspect melanoma under the nail, call the Yusupov Hospital and make an appointment with an oncologist.
The nail on the big toe is peeling, photo, cause, presumptive diagnosis, how to treat it?
A split toenail is said to occur if:
- the leading edge of the nail plate has become thinner and softer;
- the usual color of the growing part of the nail has changed to off-white, grayish;
- the tip of the nail became unsmooth, scales and peeling appeared on it;
- the edge of the nail peels off in thin sheet-like plates; it cannot be smoothed with a file.
Toenails may peel:
- with a lack/excess of calcium;
- with a deficiency of protein, sulfur, zinc, selenium;
- with hormonal imbalance;
- for chronic liver diseases;
- for some renal pathologies;
- with anemia - iron deficiency in the body;
- for endocrine disorders;
- as a result of taking certain medications;
- with frequent contact of nails with alkalis, with hot water;
- when using low-quality decorative products;
- after an unprofessional pedicure.
Often, simple measures - a balanced diet, avoiding contact with chemicals, regular nail and cuticle care - are enough to stop your nails from splitting. If you cannot cope with the problem on your own, it makes sense to consult a dermatologist or therapist.
Treatment for peeling toenails is prescribed depending on the cause of the disease. You may be recommended vitamin-mineral complexes and dietary supplements, paraffin therapy, baths with herbal infusions, applications with essential oils, medicinal varnishes and other procedures to restore the normal strong and elastic structure of the nails and stop their delamination.
