Subungual melanoma, or nail melanoma, is a rare, but very serious form of melanoma. It is actually a subtype of melanoma called acral lentiginous melanoma, which form on the palms, soles of feet and around the nail. What’s unusual is that it’s not thought to be caused by sun exposure, and it is a form of melanoma which particularly affects people with darker skin tones. When it presents as a nail melanoma, it most commonly affects the big toe or thumb.
A classic symptom is a pigmented vertical band down the nail. However, this band is not always present. Any changes to the nail bed or around the nail fold should be followed up, especially if there are symptoms of pain and/or ulceration.
Reflecting the seriousness of the condition, specific clinical guidelines have been developed to help with the quick and accurate diagnosis of the condition. These specific guidelines should be considered alongside the standard features looked for to identify melanoma on the skin and include using the “CUBED” acronym. (C – colour, U – uncertain diagnosis, B – bleeding lesions, E – enlargement, D – delay)
Podiatrists and podiatric surgeons, as well as some diabetic foot specialists, dermatologists and plastic surgeons, receive specific training on the signs to look out for that may signal that a patient has possible subungual melanoma. If suspected, an urgent biopsy is required to confirm or exclude the diagnosis.
Nail melanoma misdiagnosis
Even with rarer forms of cancer, when people are referred to a specialist, they are entitled to expect that those experts in their field, will be alert to the symptoms to look out for, and given the potential seriousness of the condition, will have a low degree of suspicion to make a referral to find out for certain, one way or the other.
Unfortunately, this does not always happen. Subungual melanoma is often misdiagnosed as ingrown nail, chronic inflammation or infection of the nail fold or granulation tissue. This means that in many cases, diagnosis is delayed.
A critical concern with late diagnosis is the increased risk of metastasis, where the melanoma cells spread beyond the original site to other parts of the body, such as the lymph nodes and distant organs. Once melanoma has metastasized, it becomes much more challenging to treat effectively, and the survival rate drops considerably. According to the Cleveland Clinic, the survival rate for early-stage nail melanoma can be quite high (around 95%). However, if diagnosed late after the cancer has spread, the survival rate can be as low as 15-20% at 5 years.
Furthermore, a late diagnosis often requires more aggressive treatment. While early-stage nail melanoma might be treated with digit-sparing surgery to remove the tumor and surrounding tissue, advanced cases may require amputation of the affected finger or toe to prevent further spread. Even with amputation, if the melanoma has already metastasized, additional treatments like lymph node removal, radiation therapy, immunotherapy, or targeted therapy may be necessary to manage the disease. The physical and emotional impact of advanced nail melanoma and its treatment can be substantial, highlighting the importance of early detection and intervention.
How we can help
At Enable Law we have a dedicated team of medical negligence solicitors who specialise in investigating and bringing claims related to delayed or missed cancer diagnosis. If you have concerns about the treatment you or a family member received, we can help you understand what may have happened and if appropriate represent you to bring a claim.
To have a free, confidential chat with a member of our specialist team headed by Kym Provan call us today on 0800 044 8488 or fill in our contact form so we can give you a call at a time convenient to you.
