Subungual melanoma is a rare but serious form of skin cancer that develops beneath the fingernail or toenail. At Tran Plastic Surgery in Huntington Beach, CA, we provide expert diagnosis and surgical treatment for this condition, helping patients achieve the best possible outcomes. Early evaluation is critical because when detected promptly, subungual melanoma can often be treated successfully with reconstructive surgical techniques.
What Is Subungual Melanoma?
Unlike traditional melanoma that develops on sun-exposed skin, subungual melanoma begins in the nail matrix, the tissue under the nail responsible for nail growth. Because of its location, this type of melanoma is frequently mistaken for bruising, fungal infections, or other benign nail disorders. Unfortunately, misdiagnosis often leads to delayed treatment, making early recognition and surgical care essential.
Dr. Tuan Tran and his team specialize in hand and nail surgery, bringing both advanced surgical skill and a reconstructive approach to help patients manage this complex diagnosis. Learn more about our broader services under Hand Surgery.
Recognizing the Symptoms
Subungual melanoma often looks different from melanomas on the skin. Key signs include:
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A dark band or streak under the nail, running from the base toward the tip (often called Hutchinson’s sign).
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Pigmentation that widens near the cuticle or spreads to the surrounding skin.
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Bleeding, ulceration, or nodules beneath the nail.
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Nail changes such as thinning, cracking, or distortion of the nail plate.
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Persistent pigmentation on only one nail (not affecting multiple nails).
In advanced cases, the tumor may grow into the bone, causing pain. However, in nearly half of cases, symptoms are subtle or absent, which makes professional evaluation especially important.
Risk Factors and Causes
While the exact cause of subungual melanoma is unknown, several risk factors increase likelihood:
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Previous trauma or repeated injury to the affected finger or toe.
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Age between 40–70 years old.
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Higher prevalence among African American, Asian, and Hispanic populations.
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Family or personal history of melanoma.
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A weakened immune system (transplant recipients, advanced HIV, etc.).
Unlike most melanomas, UV exposure is not a contributing factor.
Getting the Right Diagnosis
Because subungual melanoma is commonly mistaken for fungal infections or bruising, accurate diagnosis requires expert evaluation. At Tran Plastic Surgery, diagnosis typically involves:
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Clinical Examination
A thorough inspection of the nail and surrounding tissue using a dermatoscope. -
Ruling Out Other Conditions
Conditions such as fungal infection, subungual hematoma (bruising), or benign pigmented streaks (nevi) can mimic melanoma. -
Biopsy
The gold standard for diagnosis. A punch biopsy is often performed to collect tissue from the nail bed and matrix, which is then examined in the lab.
Accurate diagnosis not only confirms melanoma but also ensures that patients receive appropriate and timely treatment.
Staging and Severity
Once diagnosed, staging helps determine treatment options. Staging considers tumor depth, spread to lymph nodes, and potential metastasis. Common tools include:
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Sentinel lymph node biopsy
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CT or PET scans for detecting distant spread
Stages range from early, localized melanoma (carcinoma in situ) to stage IV disease with systemic involvement.
Treatment Options at Tran Plastic Surgery
Treatment for subungual melanoma almost always requires surgery. At Tran Plastic Surgery, our focus is not only on removing the cancer but also on preserving hand and foot function and appearance whenever possible.
Surgical Approaches
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Complete Nail Removal – The nail is removed to fully access the tumor.
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Excision of Tumor – The melanoma and surrounding tissues are surgically removed.
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Amputation (if necessary) – In cases where the melanoma invades deeper tissues or bone, partial removal of the fingertip or toe may be required.
Reconstruction and Hand Surgery Expertise
Because the nail and surrounding structures are essential for both appearance and function, Dr. Tran combines oncologic surgery with reconstructive techniques to optimize healing and recovery. Patients may also benefit from related procedures such as Surgical Handlift or treatment for Scaphoid Fracture of the Wrist when multiple hand conditions are involved.
Recovery and Prognosis
Early detection significantly improves survival. Unfortunately, delayed diagnosis, especially when melanoma appears in the toenails, can worsen outcomes.
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Five-year survival rates vary between 16% and 87%, depending on stage at diagnosis.
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Patients diagnosed at earlier stages typically have much higher survival rates.
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Recovery after surgery depends on the extent of excision or reconstruction but often allows patients to regain good function.
Why Choose Tran Plastic Surgery?
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Expertise in Hand & Nail Surgery: Dr. Tuan Tran is highly trained in both cancer removal and reconstructive techniques.
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Personalized Care: Each treatment plan is tailored to the patient’s condition, lifestyle, and long-term function.
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Comprehensive Services: From melanoma excision to advanced hand reconstruction, our team provides complete surgical care.
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Trusted Local Care: Serving patients in Huntington Beach and surrounding Orange County, Tran Plastic Surgery is known for excellence in surgical outcomes and patient trust.
Patient Education: When to See a Doctor
If you notice new pigmentation, a streak under your nail, or changes in a single nail, it is important to get evaluated. Even if it looks like a bruise or fungal infection, ruling out melanoma is critical.
Do not wait until the nail is painful or distorted. Early evaluation may prevent more extensive surgery later.
Schedule a Consultation
If you suspect signs of subungual melanoma or have been referred for evaluation, contact our team at Tran Plastic Surgery today.
📍 Located in Huntington Beach, CA
💻 Request an appointment online
Our compassionate team is here to provide expert care and guide you through diagnosis, treatment, and recovery.
*References:
✍️ Brannon, H. (2019). Subungual melanoma causes, diagnosis, and treatment. Retrieved from https://www.verywellhealth.com/subungual-melanoma-1069379
✍️ Cherney, K. (2017). Subungual melanoma. Retrieved from https://www.healthline.com/health/subungual-melanoma
✍️ Oakley, A. (2011). Melanoma of nail unit. Retrieved from https://dermnetnz.org/topics/melanoma-of-nail-unit/