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Dermatology (Expert Forum)
Toenail Problem
Answered by
Alan Rockoff, MD - dermatology, Child Skin Problems
The Rockoff Dermatology Center
Brookline - MA
Welcome to the DERMATOLOGY FORUM! Questions in this forum are answered by Dermatologists from St. Luke's Roosevelt Hospital, under the direction of Andrew Alexis, M.D., M.P.H.
Toenail Problem
by Charlie_Farlie, Jul 10, 2008 07:17AM
I have had pains in my upper leg (back of thigh/buttocks) for about 7 months, I finally went to my GP about 8 weeks ago and he prescribed some anti-inflammatories, these worked for a while. However about 6 weeks ago I notice that the toenail on my left foot was turning black. It might have been after going hill walking but I really cannot be sure of that. I first noticed the discolouration in the centre of the nail and there is now a dark patch growing out from the cuticle area, however it is a bit lighter below that close to the nail fold, it is still darker than normal there though, see photo links
http://i109.photobucket.com/albums/n52/gdmor10/toe/10072008.jpg
http://i109.photobucket.com/albums/n52/gdmor10/toe/09072008001.jpg
I went back to GP as my leg was still bothering me and also mentioned my toenail. He had a look at it and was concerned it could be linked, he called a colleague and she agreed.
Well I was reffered to the dermatology deparrtment of my local hospital and she was quite relaxed about it, she said that it was very likely not a melanoma as.
1 - They do not appear that quickly usually starting as a single stripe
2 - I had no pigmentation on my nail fold
3 - The area in the nail matrix although darker than normal was much lighter that discolouration elsewhere in the nail.
She wrote down subungual haematoma and sent me to get a photo taken, i have to go back in 4 weeks so they can compare the difference, however I am very aware of how dangerous it can be if its something else.
My questions to you are after looking at the photo does that sound right?
Also would the heavy darkness continue under the nail fold deep into the nail matrix?
Subungual Melanomas are a primary thing correct? i.e. it would appear before i felt pain anywhere else?
Many thanks for your help, I am less worried than I was yesterday but cannot say I am entirely satisfied with waiting another 4 weeks.
http://i109.photobucket.com/albums/n52/gdmor10/toe/10072008.jpg
http://i109.photobucket.com/albums/n52/gdmor10/toe/09072008001.jpg
I went back to GP as my leg was still bothering me and also mentioned my toenail. He had a look at it and was concerned it could be linked, he called a colleague and she agreed.
Well I was reffered to the dermatology deparrtment of my local hospital and she was quite relaxed about it, she said that it was very likely not a melanoma as.
1 - They do not appear that quickly usually starting as a single stripe
2 - I had no pigmentation on my nail fold
3 - The area in the nail matrix although darker than normal was much lighter that discolouration elsewhere in the nail.
She wrote down subungual haematoma and sent me to get a photo taken, i have to go back in 4 weeks so they can compare the difference, however I am very aware of how dangerous it can be if its something else.
My questions to you are after looking at the photo does that sound right?
Also would the heavy darkness continue under the nail fold deep into the nail matrix?
Subungual Melanomas are a primary thing correct? i.e. it would appear before i felt pain anywhere else?
Many thanks for your help, I am less worried than I was yesterday but cannot say I am entirely satisfied with waiting another 4 weeks.
Doctor's Answer
by Alan Rockoff, MD, Jul 11, 2008 05:17AM
, Jul 11, 2008 05:17AMTo: Charilie_Farlie
I agree with the dermatologist you consulted. It looks like blood under the nail (hematoma), no doubt from trauma during your hike. This came on far too fast for it to be a melanoma. I urge you to wait. There's no need for an unnecessary nail biopsy, which is not a simple procedure. In 4 weeks the dermatologist should be able to see a little clearing at the base of the dark spot as the nail grows out. It will take about a year for all of it to go away.
Best.
Dr. Rockoff
Best.
Dr. Rockoff
