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Difference Between Toenail Hematoma and Melanoma

A toenail hematoma is a bruise that forms under the toenail. Melanoma is an aggressive type of skin cancer.

What is Toenail hematoma?

Definition:

A toenail hematoma is also called a subungual hematoma and it refers to bleeding under the toenail.

Causes:

A toenail hematoma is caused by some type of injury to the toe. For instance, you may accidentally hit your toe with a hammer or somehow crush the toe causing bleeding under the nail.

Symptoms and complications:

The symptoms of a toenail hematoma include pain in the affected toe and also a dark purple bruise is seen on the nail.

Diagnosis:

The doctor can diagnose the problem by examining the affected toe and noting the color and pain. The patient also will have a history of some type of trauma to the toe.

Treatment:

Treatment depends on how bad the injury is. In some cases, taking painkillers and anti-inflammatories is recommended and then using ice to reduce swelling. In other cases, a doctor may drill a small hole (trephination) into the nail to remove the blood that is pooled underneath. If the toe is fractured, then the entire nail may need to be removed. 

What is Melanoma?

Definition:

Melanoma is a type of skin cancer that involves melanocytes (cells that make melanin). One type of melanoma is called subungual melanoma, which begins under a nail.

Causes:

Cutaneous melanoma occurs due to excess exposure to UV radiation and is most common in fair-skinned people. In comparison, subungual melanoma occurs in dark-skinned people who have many melanocytes in the skin producing melanin. This type of melanoma is thought to result from trauma and not sun exposure. Subungual melanoma occurs in African, Japanese, Native American, and Asian populations.

Symptoms and complications:

The presence of an unusual mole that is pigmented and has an irregular shape is a sign of possible cutaneous melanoma. In subungual melanoma, dark streaks of brown or black develop on a nail.

Diagnosis:

Diagnosis of melanoma, in general, is by a skin biopsy in which a piece of the affected skin is cut out and sent to the laboratory for testing. In the case of subungual melanoma, the full thickness of the nail bed is biopsied and sent for testing.

Treatment:

Treatment of melanoma depends on if it has spread or not. The first step is to cut out the melanoma from the skin where it is present. Then if metastasis has occurred, both radiation and immunotherapy can be helpful in treating this cancer.

Difference between Toenail hematoma and Melanoma?

Definition

A toenail hematoma is when there is bleeding under the nail. Melanoma is an aggressive type of skin cancer.

Causes

The cause of a toenail hematoma is some type of traumatic injury to the toe. The cause of melanoma is UV exposure or trauma to a nail.

Cancerous

A toenail hematoma is never cancerous. Melanoma is always cancerous.

Complications

Complications of a toenail hematoma would be infection and possibly the loss of the toe. Complications of melanoma are metastasis, organ failure, and death.

Treatment

Treatment of a toenail hematoma depends on how bad it is and if the toe is fractured or not. In some cases, ice, anti-inflammatories, and painkillers are enough; in other cases, the toenail may need to be removed. Treatment of melanoma includes cutting out the diseased skin tissue and, where metastasis has occurred, also radiation and immunotherapy.

Prognosis

Usually, people easily recover from a toenail hematoma and the condition is not fatal. Melanoma that is not treated can be fatal; the mortality rate is 2.5 to 5 per 100,000 cases.

Table comparing Toenail hematoma and Melanoma

Summary of Toenail hematoma Vs. Melanoma

  • A toenail hematoma can sometimes be mistaken for subungual melanoma, but a hematoma goes away.
  • A toenail hematoma is simply a bruise due to trauma.
  • Melanoma is a rare but aggressive type of skin cancer that needs rapid treatment.

FAQ

How can you tell the difference between a melanoma and a bruised toenail?

Although appearing similar, a bruised toenail will improve in time while melanoma won’t.

What does melanoma look like in toenails?

Melanoma, when present in toenails, appears as a black or dark brown color streak on the nail.

How do you know if you have melanoma under your toenail?

The presence of a dark line on the nail may suggest that you could have melanoma, but only a doctor and further testing can diagnose melanoma.

Is subungual hematoma cancerous?

A subungual hematoma is not cancerous, it is simply bleeding under the nail.

What does Stage 1 melanoma look like?

Stage 1 melanoma is very small with lesions that are smaller than 1 mm in thickness.

Is a black line on the nail always melanoma?

No, a black line can also be a splinter hemorrhage where a vessel has bled.

How aggressive is subungual melanoma?

Some doctors believe that subungual melanoma is more aggressive than the usual skin melanoma but this is also possibly a result of late discovery of the condition.

How is melanoma of the toenail treated?

The affected toenail and skin under the nail will be excised surgically. 

Does melanoma grow out with the nail?

While a hematoma does grow out as the nail grows, this is not the case with melanoma. With subungual melanoma, the line will not grow out as the nail grows.


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References :


[0]Mole, Rosalind J., and Duncan N. MacKenzie. "Subungual melanoma." StatPearls [Internet]. StatPearls Publishing, 2021.

[1]Pingel, Caleb, and Christopher McDowell. "Subungual hematoma drainage." (2018). https://www.ncbi.nlm.nih.gov/books/NBK482508/

[2]Wells, Gregory L. “Melanoma (Malignant melanoma)”. Merckmanuals. Merck & Co., 2022, https://www.msdmanuals.com/professional/dermatologic-disorders/cancers-of-the-skin/melanoma

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