The Skin Cancer Foundation Journal

MAY 2014

The 2012 edition of The Skin Cancer Foundation Journal features medically reviewed, reader-friendly articles such as tanning, the increasing incidence of skin cancer diagnoses among young women, & the prevalence of melanoma among white males over 50.

Issue link: https://skincancer.epubxp.com/i/319518

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31 4 3 2 "colorless" tumor (known as amelanotic melanoma) that may actually be red, pink, purple, or normal skin tone. 1,2,3,4 What's particularly concerning about melanomas of the nail is that they are often mistaken for a less serious condition un- til they are at an advanced stage. For example, patients may attribute a dark streak to a recent injury and ignore it. Or, these melanomas may masquerade as ingrown toenails, callus- es, warts, fungi, bruises or sores that will not heal. 1,2,3,4 Conse- quently, diagnosis is often delayed, leading to poorer outcomes. Polish can hide deadly melanomas under the nail plate. Remove it regularly to check below. A mysterious cause Although most melanomas are linked to sun exposure, the role of sunlight, if any, in the origin of nail bed melano- mas is less clear. About half of all melanomas are associated with a mutation in a particular gene – the BRAF gene – which is consistent with melanomas related to sunburn and intermittently intense sun exposure. However, this mutation is rare among people with ALM and nail bed melanoma. One possible contributing factor for nail bed melanoma is a signifcant injury to the fnger or toe. 5 Fair-skinned Cauca- sians have a much greater risk than non-Caucasian Hispan- ics, Asians, and Blacks of developing melanoma on areas of the body exposed to sunlight. However, only three percent of melanoma cases in Whites are nail bed melanomas, while people of color have a disproportionately high percentage of these skin cancers; they account for 15 to 35 percent of all melanoma cases in dark-skinned peoples. In fact, ALM is the most common type of melanoma occurring in African- Americans and Asians. 6 Delayed Diagnosis Nail melanoma is typically diagnosed later in life, be- tween the ages of 40 and 70, 7 too often at an advanced stage. As is the case with many ALMs, it is often hard to detect— particularly in dark-skinned people, for two rea- sons. First, the public and even many doctors tend to believe that dark-skinned individuals cannot develop mel- anoma, so they may not keep an eye out for it. Second, the nailbed skin frequently darkens naturally as people of color age; thus, this increased pigment is frequently ignored. Consequently, detection, diagnosis and treatment are delayed, reducing the chances of a cure. 8 This is what hap- pened with reggae legend Bob Marley, who succumbed to an ALM under his toenail. Tools for earlier recognition Due to frequent misdiagnosis, a panel of medical experts has developed the CUBED guide for the early rec- ognition of nail melanoma, as well as all foot melanomas. 7 CUBED is an acronym based on a checklist of conditions that indicate the need for a specialist's opinion: C=Colored lesions, U=Uncertain diagnosis, B= Bleeding under the nail and the appearance of beefy red tissue, E=Enlargement or deterioration of the lesion or the wound area despite treatment, and D=Delay in healing beyond two months. The well-known ABCDE acronym for analyzing suspi- cious moles can also be adapted to help diagnose nail bed

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