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blue/black (blood?) under both big toe nails

by Mark
(Greensboro NC)

About six weeks ago I noticed a black & blue roundish spot under EACH of my big toe nails. I do not remember having any trauma. I went to the podiatrist today and he sanded down one of my nails and said he "got some of the black off" which was a good sign. He also said it wasn't a long vertical line, so it was not indicative of melanoma. Still I am concerned since it doesn't seem to be "growing out". It is slightly sore to the touch, less than when I first noticed it. Any information would be appreciated. Mark

Hi Mark,
Melanoma under the nails does occur, but fortunately it is very rare. Usually the darkness is from dry blood. Having said that, the key is to see if the darkness grows forward which would then just indicate a discoloration in the nail. Six weeks is a little too soon to expect much forward growth.
Your doctor is correct in that most melanomas grow in a linear direction but that is usually from melanomas occurring at the growth plate of the nail.
If you had a melanoma just underneath the nail, it might present as a 'spot' of discoloration. The other point to consider is statistically the possibility of you having bilateral melanoma on each great toe is probably about the same as winning the megamillions lottery.
If this concerns you enough and you are hesitant to wait to see if the discoloration will grow forward, then return to your podiatrist and have him remove the nail and send out a biopsy.
The procedure is not very painful and a new nail will grow back.

Marc Mitnick DPM

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Nov 22, 2010
Thank you - update
by: Mark

Thank you very much Dr Mitnick, that is helpful and comforting. I went to my dermatoligist, and he brought in the Melaomna Spec to also look at it. They both agreed that it was highly unlikely to be Melanoma and was probably trauma. They said they saw verticle "splints?" on my nails that indicated my toe nails have had repeated tramua possibly from too small or large footwear. They said it wouldn't make sense to take the nails off and do a biopsy since "the nails would never really be the same even though they would grow back". Any thoughts? Thank you again, this helped me validate what I heard from them! Mark

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