Karolina Jasko was a senior in high school when a strange spot appeared on her right thumbnail. The technician at her local beauty salon noticed it, a thin line vertically across the nail as if she drew it with a black marker. Neither person recognized this as a potentially deadly symptom.
For the past few years, Jasko was in the habit of getting her nails done once or twice a month, a full manicure, complete with acrylics—artificial nail applicators—and a gel polish, which can only be dried with ultraviolet light.
The mark was barely visible beneath Jasko’s manicure, and she didn’t give it much thought. However, when the finger became red and swollen—an unrelated issue, but a blessing in disguise for the beauty queen—she visited her doctor. He wasn’t concerned about the infection, but he referred her to a dermatologist for black streak on her nail.
Jasko had no idea what was in store for her. The dermatologist told her to undergo a biopsy that very same day at the Northwestern Memorial Hospital in Chicago.
The diagnosis was subungual melanoma, the most dangerous form of skin cancer. 
Jasko and her mother were shocked. Since melanoma was a recurring issue in their family, Karolina was always careful about taking care of her skin and checking it for moles. Her mother had battled the deadly melanoma twice and recovered.
“It was overwhelming because everything happened so quick,” Jasko said. “It was so scary. My mom was like, ‘I can’t believe I never even thought that it could be in your nail.’”
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Jasko went into surgery to remove the entire nail matrix. If cancer had progressed, doctors would have had to amputate the whole thumb, but fortunately, the melanoma was caught in its early stages.
“Early detection of nail melanoma is important,” says board-certified dermatologist and nail specialist Shari Lipner, MD, PhD, FAAD. She stresses the importance of regular examination of one’s whole body for signs of skin irregularities, including the nails. 
“They still don’t know where the infection came from,” said Jasko about the swelling that took her to her doctor in the first place. “They said that was like a sign from God because if I would have waited longer and not come in with that, it could have been possible the melanoma would have spread.”
The fortunate cancer survivor went on to win Miss Illinois in 2018 and then compete in the Miss USA pageant. She is now 21 and a student at the University of Illinois at Chicago.
Her story brought a new awareness to the rarest form of melanoma.
“I’m very thankful they saved my thumb and that nothing worse happened,” Jasko said.
How to Identify Nail Melanoma
The most common sign of subungual melanoma, as seen with Jasko, is a black or brown line in the nail. It’s often found on the thumb or big toe of one’s dominant hand, but it could appear on other nails, says Dr. Lipner. 
Many people delay seeing their health practitioner about this issue because they assume the line is from a bruise. After all, everyone stubs their toe or hurts their finger from time to time. Many people with dark skin have natural streaks in their nails. These are normal and do not change in size. 
There are also other causes for this strange line, such as blood under the nail from injuries or too-tight shoes, a benign infection, or residual pigment from silver nitrate or newspaper print.
However, there are symptoms that distinguish melanoma from other causes of dark nail lines. These include:
- Pigmentation on the adjacent skin
- Nails splitting or bleeding
- Other infection-like signs, including pus, drainage, and pain, 
- The line increases in size
- No known injury to nails
- The nail separates from the nail bed
- The skin next to the nail darkens or becomes deformed. (This is an advanced stage.) 
How to Prevent Nail Melanoma
Melanoma has several notable risk factors, including:
- Finger and toe injuries,
- Previous history or family history of the disease,
- A genetic condition called xeroderma melanoma, where one’s cells are unable to repair sun damage,
A weakened immune system from:
- Infections, like HIV,
- Drugs (including chemotherapy and immunosuppressants,)
- And the presence of other cancers, like lymphoma. 
Anyone can develop this disease, but the chances are higher among the older population and people of color. 
The exact cause of nail melanoma has not yet been found, so it’s difficult to be completely prevented. However, as Dr. Lipner maintains, proper examination and care can prevent this disease from progressing, just like in the fortunate case of Jasko.
- Self-examine your skin from head to toe, at least once a month.
- Book a professional skin exam from your health care provider once a year.
- Remove nail polish before doctor appointments so your practitioner can inspect your nails.
These examinations are important especially for those taking immunosuppressants or those with a weak immune system. 
Skip the Gel Polish?
Dr. Vishal Patel, assistant professor of dermatology at the George Washington University School of Medicine & Health Sciences in Washington, D.C. and other experts worry that cases like Jasko’s might increase with the popularity of gel manicures that require ultraviolet light to harden.
“It’s like tanning beds for your hands,” says Dr. Patel. “We’re seeing a lot of patients having not only melanomas but all types of skin cancers around the fingertips and the cuticles.” Dr. Patel is also the director of the cutaneous oncology program at the GW Cancer Center. 
Some studies have shown that cancer risk from the UVA rays emitted from lamps used in gel manicures is low . However, it was also shown that hands exposed to the lamps for 10 minutes received the same amount of energy as the daily allowable limit for out-door workers .
Low risk is still a risk, and if you’re frequently exposed to these lamps or UV rays in general, it’s important to do what you can to help further reduce the risk. If you feel you need the extra protection you can:
- Wear fingerless gloves with UV protection or apply natural sunblock onto your hands about fifteen minutes before getting a gel manicure.
- Wear sunscreen or even gloves on your hands when you drive.
- When you’re outside, apply a natural sunblock to your whole body, even on your hands and nails.
To this day, Karolina Jasko skips the gel polish and the UV exposure at her nail salon and opts for regular polish instead, in addition to having her skin checked every four months. Because of her family history with this form of cancer, it’s difficult for experts to determine how much of her previous manicure habits contributed to her disease.
“If you have the slightest concern about something on your nail,” says Jasko, “go and get it checked out by a dermatologist; it could end up saving your finger—or your life.”
- Melanoma https://www.skincancer.org/skin-cancer-information/melanoma
- Early detection essential for nail melanoma https://www.aad.org/media/news-releases/nail-melanoma
- Subungual Melanoma https://dermatology.ca/public-patients/nails/subungual-melanoma/
- Subungual Melanoma https://www.dovemed.com/diseases-conditions/subungual-melanoma/
- Cancer, Melanoma, Subungual https://www.ncbi.nlm.nih.gov/books/NBK482480/
- Dr. Vishal Patel https://cancercenter.gwu.edu/profile/doctor/vishal-patel
- Further Investigation Into the Risk of Skin Cancer Associated With the Use of UV Nail Lamps https://jamanetwork.com/journals/jamadermatology/fullarticle/1862050
- Acrylic nail curing UV lamps: High-intensity exposure warrants further research of skin cancer risk https://www.jaad.org/article/S0190-9622(13)00906-7/fulltext
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