Disappointed tbh, I posted my first thread on here today and not one person (even moderator) responded ?!

Hi Chrissie8364.  Welcome to the forum.

I am not a doctor and I have no medical qualifications.

Subungual melanoma is very rare, and most marks under the toenail are the result of trauma.  I haven't worn shoes (just flip-flops when I'm outside) since April, and hence my toes have suffered a few accidents.  If you're anything like me, then the mark on your toenail is probably the result of a minor accident that you've subsequently forgotten about.  In my experience, a trauma has to be really bad for it to hurt more than a couple of hours. Even when I dropped a brick on my big toe and smashed the nail a few years ago, the pain had gone after a couple days, but the mark lasted for months.  

Don't be too worried about the referral.  It is pretty much impossible for a GP to differentiate between a bruise and a subungual melanoma just by inspection so most doctors prefer to play it safe and always refer.  In fact, even specialists can have the same difficulty, so don't be too surprised if you're referred for a "punch" biopsy.  

Just don't fall into the trap of thinking that the doctor (or specialist) thinks you have melanoma and the biopsy is a mere formality to prove the suspicion.  It doesn't work that way.  For nearly all cancer testing, if you meet certain criteria set by NICE or the hospital itself, then you get the test, or scan, or biopsy.  And the bar is set really low, so that 80-90% of people tested are given the all clear, but hopefully no-one who really does have cancer is accidentally missed. 

Hi Chrissie,

I'm sorry you have this worry and you hadn't had a reply at first. Subungual melanoma isn't common so there aren't many people on here who have personal experience of it. Those on the forum that have had the same problem as you tend not to stay here if their referral or biopsy has led to a benign diagnosis, so that means there are very few members to reply to your question. All that being said, if you search on Subungual in 'search forum' at the top of the page, you will see other posts that may help you. There are two members who sometimes pop back in that did have a diagnosis of SM - LouiseandFin is one and RickyB is another.

I have been a cutaneous melanoma patient for many years and although I have no personal experience of SM I have spoken to many who have. SM only accounts for 4-5% of melanoma diagnoses and three quarters of these are in patients of dark skin (black, Asian and Oriental) so the odds that your nail is SM are very low. Fungal nail infections don't usually cause pain, and trauma only causes pain if you've really given your toe a whack, in which case you would be aware of it - so the lack of toe pain doesn't really signify what it may be. Have you been wearing tight fitting shoes recently, high heels or new shoes that you are not used to? Sometimes trauma can be caused over a period of time this way - my husband always get's marks on his big toe when he wears new walking shoes as they are too tight in the big toe area until he's worn them in.

As Telemando advises, the GP can't tell what the cause of the problem is by looking at it - only a dermatologist can, & even they may feel the nail needs removing for biopsy of the skin underneath.

So don't panic if this is advised - biopsy is the only 100% way of getting a correct diagnosis.

You have found it quickly which, if it is SM, is very much in your favour for successfully being treated. Try not to worry - of the posts on here that you will find on a search, you will see that many have had a benign result & those that don't come back to update members is because they too have had a benign result. Hang on to these positives as the odds are in your favour. 

Good luck and please let us know how you get on,

Angie (Stage 3 melanoma patient)

Hi Chrissie

How did you get on?

I was referred back in February, Dermatologist decided to observe as I was diagnosed with a BCC at the appt.

Going next week for a biopsy on my nail as the brown line has widened significantly since Feb - slightly panicking.