Skin cancer under the nail will generally take one of three forms. Moreover, melanoma is the most common type of skin cancer that affects the nail bed, even though other types of skin cancer—like basal and squamous cell skin cancers—are more common on the whole. Subungual (nailbed) melanoma is a rare but serious type of skin cancer under the nails. Find out how to identify skin cancer on nails, and ask your doctor about any significant changes to the appearance of your nails.

Types of Skin Cancer on Nails 

Skin cancer under the nail generally falls into one of three categories:

• Acral lentiginous melanoma, the most common form of skin cancer on nails, looks like a dark band that runs from the nail matrix (where the nail begins to grow) outward toward the edge of your nail.
• Nodular melanoma takes the form of a bump that may originate beneath the nail. Onycholysis — where your nail is pushed up and detached — is a common symptom.
• Demoplastic melanoma, while most commonly found near the neck and head, can also be found on skin near the nails. This type of melanoma is named for the fibrous tissue that surrounds the tumor. It most often presents as a skin-colored or pink bump with a smooth or irregular surface, but it may take on darker shades.

How Does Skin Cancer Appear on Nails?

Between regular dermatologist visits, you can check for signs of skin cancer under your nails at home. Be on the lookout for any of the following signs: 

• Dark streak under the nail. The streak may appear as a brown or black band in the nail. Typically, these streaks appear on the thumb or big toe of the dominant hand or foot, but can appear on any nail. 
• Dark skin next to your nail. Darkened skin around the nail can be a warning sign of advanced melanoma. 
• Nail lifting. This occurs when the nail begins to lift from the nailbed on the finger or toe. As the nail lifts, the white free edge at the top of the nail will start to appear longer. 
• Nail splitting down the middle. 
• A bump or nodule beneath the nail. You may also see a band of color on the nail that’s wide and irregular or narrow and dark. 

Who’s at Risk of Developing Fingernail Cancer? 

Anyone can develop nail cancer, but it’s more commonly seen in older people and people of color. A personal or family history of skin cancer can indicate a higher risk of developing skin cancer on nails. Subungual (nailbed) melanomas are rare. They’ve been seen in about 0.07% to 3.5% of the people in the world who have melanoma. Subungual melanomas have been seen in 75% of African, 25% of Chinese, and 10% of Japanese people who have been diagnosed with melanoma. Most commonly, they affect women in their 60s and men in their 70s.  ‌‌ 

Do You Need Surgery to Treat Skin Cancer on Nails?

In most cases, a form of Mohs surgery is required to treat skin cancer on or under nails. This surgery almost always requires the removal of the nail, and in the most advanced cases, some degree of amputation may also be required. However, when caught early, the aftereffects may be fairly minimal.

You may have noticed that the three most common types of skin cancer on the nail are all forms of melanoma. Common skin cancers on the nail is an atypical occurrence, but certainly not unheard of. Any slow-growing skin cancer area near the nail should be investigated for basal cell skin cancer. Squamous cell skin cancer is most likely to present with onycholysis and redness.

If you notice any significant changes in nail appearance, or if you notice a blemish that does not heal in a reasonable amount of time, ask your dermatologist to inspect the site. 

Consider GentleCure for Skin Cancer Treatment

GentleCure™ — the surgery-free alternative to Mohs — is often an option for those facing a diagnosis of basal or squamous cell skin cancers. Ask your doctor to find out if it’s right for you.