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Difference Between Subungual Hematoma and Melanoma

While a melanoma (malignant melanoma – a tumor of melanin-forming cells) is a cancerous spot that can sometimes form underneath the toenail, a hematoma (haematoma, or blood suffusion is a localized bleeding outside of blood vessels) is a collection of blood beneath the nail, like a scab that is visible through the toenail.

Similarity

Both can cause pigment in or beneath the nail, but unlike a subungual hematoma (blood beneath the nail), a melanoma is mostly not painful and is not associated to an injury.  

Subungual Hematoma

Subungual hematomas are injuries of the nail bed (when you crush your finger or drop something heavy on it) in which bleeding develops under the nail. It can cause symptoms like throbbing and intense pain under the nail. It happens if your crush your finger or drop a heavy object such as a dumbbell on your toe.

Melanoma

Malignant melanoma (a cancer of skin cells called melanocytes) is a serious form of skin cancer that begins in cells known as melanocytes. The symptoms involve bigger mole diameter, hyperpigmentation and mole color changes. It can occur anywhere in the body. 

Difference between Subungual Hematoma and Melanoma 

Definition

Subungual Hematoma

Subungual Hematoma are injuries of the nail bed when you crush your finger or drop something heavy on it and in which bleeding develops under the nail

Melanoma

Melanoma is a serious type of skin cancer (skin malignancy) and is also called as malignant melanoma. It happens when there is unrestricted growth of melanocytes (pigment-producing cells located in the basal cell layer) 

Causes

Subungual Hematoma

  • Injury to the blood vessels beneath the nail bed

Melanoma

  • environmental and genetic factors
  • tanning beds and lamps 
  • exposure to ultraviolet (UV) radiation from the sun

Symptoms

Subungual Hematoma

  • blood beneath the nail
  • tenderness and intense pain in the nail
  • feeling of pressure under the nail
  • discoloring of the nails

Possible signs of an infection include:

  • pus coming out from beneath the nail
  • temperature
  • red streaks in the skin
  • throbbing in the finger or toe and feeling heat
  • extreme swelling and pain
  • excessive redness around the area of injury

Melanoma

  • redness or a new swelling beyond the border of the mole
  • the growth of a new pigmented or unusual-looking tumor on your skin
  • bleeding from the mole
  • pain in the mole
  • lump beneath the skin
  • swollen lymph nodes 
  • gray skin
  • headaches

Treatment

Subungual Hematoma

  • Simple trephination – a surgery in which a small hole is made in a nail allowing the blood to drain and relieve pressure

Melanoma

  • Surgery, medication, chemotherapy, radiation

Summary

The points of difference between Subungual Hematoma and Melanoma have been summarized as below:

FAQ:

What does melanoma look like under nail?

A melanoma looks like a brown or black streak under a toenail or fingernail. Sometimes it may be mistaken for a bruise. It also appears as a narrow brown to black pigmented band, that can be seen on the length of a single nail plate (melanonychia)

Is it blood under my nail or melanoma?

With a hematoma, accumulation of blood in the nail bed is visible within a few days of a crushing injury (a crush injury occurs when force or pressure is put on a body part). In contrast to melanoma (malignant melanoma), nail discoloration from hematoma will gradually wade off as the nail starts healing. As the nail heals from a subungual hematoma (injuries of the nail bed in which bleeding develops under the nail), a transverse groove may form across its surface.

How do I know if my toenail is black or melanoma?

With melanoma, a trauma blood blister doesn’t move because the discoloration is not actually in the nail, it’s in the skin beneath the nail. The melanoma does not change even when trauma grows out

What does Stage 1 melanoma look like?

Stage I melanoma is no more than 1.0 mm thick (a ‘thin melanoma’) (1.0 mm is the size of a pencil with a thin and sharpened pencil point). The tumor may or may not have ulcerated (broken skin). Stage 1 melanoma is the least grave type of melanoma. 

In Stage I melanoma, the malignant (cancer cells) are in both the epidermis and the dermis (first and second layers of the skin). 


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References :


[0]Cohen, P. R., Schulze, K. E., & Nelson, B. R. (2007). Subungual hematoma. Dermatology Nursing, 19(1).

[1]Coit, D. G., Andtbacka, R., Bichakjian, C. K., Dilawari, R. A., DiMaio, D., Guild, V., ... & Wong, M. K. (2009). Melanoma. Journal of the National Comprehensive Cancer Network, 7(3), 250-275.

[2]Oztas, M. O. (2010). Clinical and dermoscopic progression of subungual hematomas. International surgery, 95(3), 239-241.

[3]Schadendorf, D., van Akkooi, A. C., Berking, C., Griewank, K. G., Gutzmer, R., Hauschild, A., ... & Ugurel, S. (2018). Melanoma. The Lancet, 392(10151), 971-984.

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