Fingernail health: Unveiling the hidden risk of skin cancer in people of colour

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By Samantha Simon
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Skin cancer is a growing concern worldwide, affecting millions of individuals each year, and according to Dr Damian Gordon of Blue Haven Medical, it is a type of cancer that persons of colour, especially living in the Caribbean, should be conscious of.

While skin cancer predominantly occurs on the skin’s surface, it can manifest in unexpected places, including the fingernails.

Dr Gordon explained that it is particularly concerning for people of colour, as skin cancer most frequently occurs on the hands, feet, face and top of the head.

The awareness and understanding of skin cancer in nails are often lacking, he said, making early detection and prevention more challenging as most people do not know what to look for.

Skin cancer, Dr Gordon explained, is broken into two main groups – melanoma and non-melanoma. The latter is further broken down into basal cell carcinoma, merkel cell cancer, and squamous cell carcinoma, and both are often associated with excessive sun exposure and fair skin.

Melanoma, whilst the more aggressive of the two types, is also rarer, with most cases diagnosed locally presenting as non-melanoma, according to Dr Gordon.

He emphasised that skin cancer can affect people of all ethnic backgrounds.

For many persons with darker skin, there is a misconception of being immune to skin cancer. That notion can lead to delayed diagnosis and treatment, which can cost persons fingers, toes, entire limbs or their life, as the cancer can metastasise (spread to other tissue and organs in the body).

Skin cancer in nails, also known as subungual melanoma, is a rare but potentially life-threatening form of skin cancer. It occurs when melanoma, a type of skin cancer that originates in pigment-producing cells called melanocytes, develops underneath the nail or in the nail bed. This type of skin cancer can occur in people of all skin types, including those with darker skin.

To the naked eye, it presents as a vertical line of discolouration that is a singular colour within the nail, with the tip of the nail where the discolouration ends being significantly more brittle and damaged compared to the surrounding nail.

As the cancer progresses, a dark spot may also present on the skin at the base of the nail where the discolouration begins.

Dr Gordon recommends that once a line of discolouration appears on the nail that persons have it checked out. This aggressive form of cancer can spread with terrifying speed, and once it passes into stage two cancer and beyond, amputation is often considered as the main treatment option.

The process of diagnosis is relatively simple, and can result in the full removal of the cancer if caught in the early stages.

A dermatologist with the required tools and equipment will evaluate the affected area before performing a biopsy, removing the area of discolouration as much as they can, to ensure that all of the potentially cancerous cells are removed to avoid having to return for further invasive procedures should the biopsy results return from the pathologist as cancerous.

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Subungual Melanoma (Skin Cancer in the nail)

In the case of a nail biopsy, the dermatologist will remove the affected nail, nail bed and any surrounding affected tissue within the finger or toe, with as little as a 2mm buffer, to ensure that all of the possibly cancerous cells are removed.

Should the pathologist find that the cancer is deeper than 2mm into the skin, it is said to have progressed past stage two skin cancer, and the patient will be referred to capable surgical and oncological doctors for further treatment.

Sadly, as explained by Dr Gordon, with the closure of the country’s cancer centre, the resources for treatment of skin cancer past stage two are extremely limited, and access to more modern treatment and medication are limited to private doctors sourcing it as they are not available within the Medical Benefits Scheme.

One of the primary challenges for people of colour is misdiagnosis and late presentation.

People of colour are more likely to present with advanced-stage skin cancer due to the delayed diagnosis.

Healthcare professionals and patients alike may not immediately associate nail discoloration or changes with skin cancer, especially if the person has a darker skin tone.

This delay in diagnosis can lead to more advanced stages of cancer, making treatment less effective.

Subungual melanoma can also be mistaken for more benign conditions, such as fungal infections or trauma within the nails, further delaying appropriate medical intervention.

Prevention and early detection are crucial for managing skin cancer in nails effectively. Here are some steps that people of colour can take to protect themselves:

1. Self-examination: Regularly inspect your nails for any changes, such as discoloration, streaks, or unusual growths. Pay attention to the ABCDE criteria (Asymmetry, Border irregularity, Colour variation, Diameter larger than 6mm, Evolving) to identify potential warning signs.

2. Professional examination: Consult a dermatologist or healthcare provider for a thorough examination if you notice any suspicious changes in your nails. Early diagnosis greatly improves the chances of successful treatment.

3. Sun protection: While subungual melanoma is not directly caused by UV exposure, protecting your skin from harmful UV rays remains essential. Wear sunscreen and protective clothing when spending time outdoors, and avoid tanning beds or high UV exposure activities.

Dr Gordon recommends the use of sunscreen with a maximum of 50SPF as most sunscreens higher than that are classed as chemical sunscreens which can potentially cause damage to the skin by soaking into it and creating a chemical barrier.

He also recommends, during times of full exposure to the sun, that sunscreen be reapplied at least every 20 minutes to the areas most affected by direct sunlight.

Skin cancer in nails is a serious but often overlooked risk for people of colour. It is essential to break the misconception that skin cancer only affects those with fair skin and to promote awareness about this condition in all communities.

By understanding the unique challenges and risks, individuals can take proactive steps towards prevention and early detection, potentially saving lives and reducing the impact of skin cancer in fingernails among people of colour.

If you are concerned about a possible presentation of symptoms or have queries regarding dermatological care, Dr Gordon welcomes persons to make an appointment with Blue Haven Medical Centre by calling 727-4088 or visiting the centre on Old Parham Road, west of the Top Ranking store.

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