Black stripes on fingernails, is it skin cancer?

My fingernails recently developed black stripes along the length of the nail. Is this a symptom of skin cancer? (Hoang, 40 years old, Hanoi)

Reply:

Banded nail pigmentation is a medical term used to describe black or brown pigmentation of the nail, characterized by the appearance of a pigmented band (partial or complete) running along the length of the nail.

The disease is characterized by the deposition of pigment cells called melanoctytes in the subungual area. These pigment cells are often linked together, along with the longitudinal growth of the nail, causing brown or black hyperpigmented lines on the nail.

Just looking at this sign does not confirm melanoma. In fact, there are many causes of black or brown pigmentation of the nails, including nail trauma, warts, nail fungus, nail psoriasis (an autoimmune disorder), lichen planus (an inflammatory skin condition believed to be autoimmune), chronic paronychia, infectious granuloma, Addison's disease (adrenal insufficiency due to autoimmune disease, cancer, infection or pituitary tumor), chemotherapy, radiation therapy.

Subungual melanoma is mainly found in people over 50 years of age and is considered rare, accounting for only 0.7-0.35% of all skin cancers. Signs of the disease include lesions that cover more than two-thirds of the nail plate; gray or black-brown color, irregular brown and granular pigmentation, variations in color and thickness of the stripes, and deformation of the nail plate. One of the main signs of subungual melanoma is the "Hutchinson sign" (increased width of the pigmented band near the nail base or on both sides).

Benign lesions are recognized by the appearance of light to dark brown, parallel, regular stripes of color, with well-defined borders and a width usually less than 3 mm or about 1/10 inch.

Subungual melanoma can only be diagnosed definitively by a nail biopsy. Therefore, if you notice unusual pigmentation in your nails, you should see a dermatologist for examination and evaluation.

Nurse Dang Thi Diu Hien
Dermatology and Allergy Center, 108 Central Military Hospital

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