黑色素瘤

Can You Get Melanoma in Your Toenail?

You can get skin cancer just about anywhere. When it comes to your nails, this is what to watch for.

by安德里亚黎明·克拉克（Andrea Dawn Clark） 卫生作家

2022年9月6日

Medical Reviewer

亚伦·法伯格（Aaron S. Farberg），医学博士

Getty Images/yacobchuk

2022年9月6日

Medical Reviewer

亚伦·法伯格（Aaron S. Farberg），医学博士

你有没有slipped on some sandals, looked down at your toes, and noticed an unusual dark spot on your toenail? It’s possible you stubbed your big toe or dropped something heavy on your foot that caused bleeding underneath the nail. If so, expect that bruise to change in color from red, to purple, to dark brown or black as the blood is resorbed and a new nail grows out. But if you don’t recall any run-ins with the sofa and the mark doesn’t disappear after a few weeks, you might want to get your toenail checked for a certain—sometimes elusive—type of cancer.

什么是趾甲黑色素瘤？

您可能听说过melanoma，一种皮肤癌，可打击皮肤的色素生产细胞或黑素细胞，但也许不认为这意味着它也可以在您的脚趾甲和指甲的皮肤上“在兜帽”中出现nail bed。Yikes.

实际上有numerous kinds of melanoma这种变体，称为subuncual（又称钉子下）黑色素瘤，仅占0.7% to 3.5%全球恶性黑色素瘤。纽约市Marmur Medical的董事会认证皮肤科医生Rachel Westbay博士说：“典型的黑色素瘤通常会影响大脚趾或缩略图，占所有病例的75％至90％。”

Westbay博士还指出，有色人种（即黑人和亚洲人民）中有较高的undual黑色素瘤患病率：“这是在色素沉着的人中诊断出的最常见类型的黑色素瘤类型，可能是由于该人群的皮肤黑色素瘤发病率低。与皮肤黑色素瘤相反，典型性黑色素瘤似乎与阳光暴露无关。”在这种形式的黑色素瘤可能有多严重的情况下，雷鬼图标可能是多么严重的例子鲍勃·马利当他的脚趾转移时，可悲的是死亡。牙买加歌手believedthat the dark spot under his toenail had instead been caused by a soccer injury.

但是，当被捕获并接受治疗时，亚uncunal瘤的存活率很高。在最早的阶段，五年生存率约为97％，10年生存率约为95％。技巧：监视指甲上的任何斑点，注意任何变化，并看到皮肤科医生是否看起来可疑。

区分典型黑色素瘤与脚趾甲真菌

您的脚的镜子时间不如身体其他部位，但它们可以揭示一定signs of trouble健康。例如，脚趾甲（和指甲）是隐身的地方癌症可以出现在您体内的地方。

那么，您应该在寻找什么？“总的来说，亚ungual黑色素瘤是一个正在扩展的黑点，或者是纵向色素的条纹，它扩大或延伸至指甲周围的皮肤。”位于宾夕法尼亚州普鲁士国王的董事会认证的皮肤科医生Erum Ilyas说，”，与Schweiger皮肤病学小组。换句话说，想象一条垂直的赛车条纹在指甲下方延伸到角质层。同样，与简单的瘀伤不同（或subungual hematoma），随着指甲长大，这个黑点不会消失。

根据Westbay博士的说法，另一个Telltale标志是黑色或棕色的斑点变得更宽且不均匀。“如果色素带的宽度大于3毫米（mm），尤其是在角质层附近；色素沉着变得更加不规则，例如浅棕色阴影的混合物；或形成模糊的边界，延伸到指甲褶皱周围的皮肤（或指甲的底部），您有指甲黑色素瘤的历史指标。”她说。

但是，并非所有的指甲黑色素瘤都具有独特的阴影。Westbay博士说，实际上，多达一半的指甲黑色素瘤的色素很少，要么完全缺乏色素。这意味着应监测任何持续的疼痛，变薄，破裂，出血或指甲失真，因为无色指甲黑色素瘤可能是罪魁祸首。

伊利亚斯博士说，奇怪的是，许多患者担心他们可能患有指甲黑色素瘤实际上使难看的脚趾甲标记与从更常见的状况中得出的那些脚趾甲标记混淆了，nail fungus。这两个问题都会导致变色和畸形的脚趾甲，但就指甲真菌而言，脚趾甲变黄和变稠（与更薄的相对），边缘可能崩溃。

是什么原因导致undual黑色素瘤与脚趾甲真菌？

典型黑色素瘤的确切原因尚不清楚。Westbay博士说：“研究人员确实知道，这种类型的黑色素瘤与其他类型的黑色素瘤不同，因为它与阳光无关。”疾病的危险因素包括严重伤害，损害或指甲创伤；有亲密的家庭成员患有次词黑色素瘤；以及对皮肤癌的已知易感性的遗传突变。

Meanwhile, the cause of toenail fungus is clear-cut.根据克利夫兰诊所的说法, the infection usually occurs when certain fungi get through a “crack or cut in your toe,” allowing the invaders to embed between the toenail and the tissue just underneath. “Nail fungus, also known as onchyomycosis, develops as a result of a fungus under that nail plate, triggering a buildup of debris under the nail plate, thickening of the nail plate, and a white chalky residue,” explains Dr. Ilyas.

If your doctor is not able to diagnose toenail fungus on sight, they may take some nail clippings to be tested to determine the cause of your nail symptoms. Besides prescription oral and topicaltreatments, there are some over-the-counter creams like terbinafine (Lamisil) that can help—although treatment for toenail fungus isn’t always needed,根据梅奥诊所。与您的医疗保健提供者交谈，以查看哪种方法适合您。

亚uncunal Helanoma诊断和治疗

如果皮肤科医生检查您的脚趾甲并找到有关的任何标记或物理迹象，那么他们很可能需要对指甲床进行活检。伊利亚斯博士说：“指甲本身有点像看下面的皮肤。”“需要对指甲板下的皮肤进行活检，以查看病变是否符合暗示皮肤癌的标准。”

If a melanoma is detected via the biopsy, your dermatologist will determine what next steps are required to remove it. “If the melanoma is confined to the epidermis [top layer of skin], then it may be managed conservatively by wide surgical excision of the entire nail apparatus with margin control,” says Dr. Westbay. If the subungual melanoma has spread beyond the skin just below the nail and further into the toe itself, it is considered invasive. Although “traditionally, this has required complete amputation of the digit,” says Dr. Westbay, don’t panic: There is another approach that can preserve the bone and joints of the affected toe calledMohs micrographic surgery。

在此手术中，在显微镜下去除并研究了癌症部位的一层薄组织，并检查是否有癌症的迹象。重复该过程，直到在去除组织层中没有看到癌症的迹象为止。

In cases of metastatic melanoma, where the cancer has spread beyond the toe to another area of the body, “免疫疗法通常选择代理商。” Westbay博士说。

When to See a Doctor

Many of us may take our feet for granted but it’s smart to give them some regular heel-to-toenail attention when we kick off our shoes, scrub them in the shower, or prep them for a pedicure. And if you notice unexplained discoloration in your toenails or symptoms like persistent pain, thinning, cracking, bleeding, or nail distortion, see your health care provider or dermatologist to have them examined. Remember: With early detection, subungual melanoma is highly curable, so stay calm and connect with a qualified dermatologist who can make a treatment plan specifically for you.

Meet Our Writer

安德里亚黎明·克拉克（Andrea Dawn Clark）

安德里亚黎明·克拉克（Andrea Dawn Clark）is the Editorial Director at John Jay College, City University of New York (CUNY). With over 20 years of professional publishing experience, she’s worked at numerous consumer magazines as an Executive Editormore

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