Dr. Payal Chauhan
Dermatology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
I am a 29-year-old male and I found a tiny spot under my nail. Six months back, I dropped a big plate on my toe and it became blue due to impact. I was not able to walk for two weeks. After the disappearance of blue, my nails have become yellow or golden color at the tip and I think that I have a yeast infection. After this, my nails next to it has become infected. The main toe has started to have some nail growth sideways. It has been a month of having a tiny spot under my nails. It seems to be a subungual blue nevus. I heard that these are extremely rare to occur under nails. I want to know whether these are blue nevus and please say whether it is harmless. The tiny spot still remains the same without having any changes in size. Kindly suggest.
Hi,
Welcome to icliniq.com.
I understand your concern. Though it looks like blue nevus, it is rare to occur in a subungual area in the acquired state (attachment removed to protect patient identity). Though it remains harmless. it can have a malignant transformation rarely. It is indicated by a sudden increase in size, changes in color, involvement of surrounding skin, and changes in nail structure. Kindly observe these conditions. Though it is rare, subungual melanoma occurs more commonly than blue nevus. If the trauma has occurred recently, then it can be a subungual hematoma. But it has been six months and so subungual hematoma occurs unlikely in your case. Kindly observe it. Do a biopsy to confirm it and doing dermoscopy helps a lot.
Patient's Query
Thank you doctor,
You have mentioned that it has a higher chance to be subungual melanoma. It made me worried. It remains tiny. As you are saying that it can be blue nevus or melanoma, it makes me more worried. I took another picture with better lighting. Kindly go through it.
Hi,
Welcome back to icliniq.com.
Out of blue nevus and subungual melanoma, the latter is more common to occur. But it can also be a hematoma or some vascular malformation. Please mention whether it appeared after a month of trauma. Then hematoma can be a cause. In this case, you need to observe it. If it is a hematoma, it disappears within few weeks. You can confirm it by doing a biopsy. In your case, it looks more like blue nevus.
Patient's Query
Thank you doctor,
When I did some research, I came to know that melanoma occuring on the nail area can have misformed lesions or black vertical lines. Subungual melanoma appears hard and rare to occur. They do not appear blue. It appears in black and brown. Blue nevus can turn malignant if they appear larger than two millimeters. Kindly suggest.
Hi,
Welcome back to icliniq.com.
You need to observe your condition for few weeks. Toenails take around six to nine months to grow and so a resolution of hematoma takes some time. You can take weekly photographs of the lesion and you can monitor it more accurately. After four to six weeks, you can assess once again. Please mention whether you have any photos of the initial stage of the lesion. It helps me to assess the progression of the lesion. If yes, kindly send it. Kindly do a dermoscopic examination soon. If you notice any changes in size, color, or border, then do a histopathological examination immediately.
Patient's Query
Thank you doctor,
Initially, it did not notice anything. After a week, I saw a tiny spot. Now it has been 40 days. I did not see any changes in size or color. I know that subungual melanoma cannot present as blue color but usually black or brown. Only a type of blue nevus that turns malignant is cellular blue nevi. On considering the size of the lesion, it cannot be a cellular blue nevus. If I see any changes, I will go for a histopathological examination soon.
Hi,
Welcome back to icliniq.com.
Yes, subungual melanoma cannot be bluish. But it can present as blue in some cases. Also, a regressed melanoma can be like a blue nevus. But in your case, it looks more like blue nevus clinically. Usually, they are harmless and smaller. The larger variant of it called cellular blue nevus can turn malignant.
Patient's Query
Thank you doctor,
I will update you after six weeks with a new picture.
Hi,
Welcome back to icliniq.com.
Ok, fine.
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