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Subnugal melanoma? Toddler, should I push for a biopsy.

EHGR
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Hi everyone,

I’m feeling really anxious and would love some advice or reassurance. My little one (2 years old) has had a vertical black line on their thumb for about 5 months. It’s around 2mm, no history of trauma, and in the last month, it has definitely grown and darkened—though not dramatically, it’s still noticeable.

We were referred to the dermatology unit at the hospital, and today we had our appointment. One specialist examined it and told their colleague they would recommend a biopsy because the line seems to extend slightly ito the nailbed. However, their colleague said that they don’t usually do biopsies in children that young and prefer to monitor instead as it is usually benign

They then called in another doctor for a third opinion. She reassured us that subungual melanoma is extremely rare in children—so rare that she doesn’t think there’s ever been a reported case in a child this young. She also said the borders were straight and regular, so she wasn’t concerned and decided against a biopsy. Instead, they took photos and plan to review it again in a few months.

What’s been playing on my mind is something I overheard. One doctor asked, “So do we not usually check again on children this young?” and the senior doctor responded, “Not usually.”

Now I’m worried—why did she say that? Does this mean they’re considering the possibility of something serious but don’t want to alarm me? Should I push for a biopsy now instead of waiting?

I just can’t shake the anxiety, and I don’t want to regret not acting sooner if it turns out to be something serious. Has anyone been through something similar? Would really appreciate any advice or thoughts.

Thank you

  • Welcome to the forum, EHGR,
    I can hear how anxious you must be feeling right now, and it’s completely understandable given the situation. It’s always so worrying when it comes to our little ones, and it sounds like you’re doing everything you can to make sure they get the right care.
    It’s good to hear that you've already seen specialists and that they’ve decided to monitor the situation for now. It’s reassuring to know that subungual melanoma is extremely rare in young children, and I’m sure the doctors are considering all factors when making their decisions. The fact that they’re taking photos and planning to reassess it in a few months shows they’re keeping a close eye on it, which must offer some reassurance.
    That said, it’s natural to feel uncertain, especially when you overhear things that raise more questions. If you’re still feeling unsure or anxious, it might help to ask the medical team for a bit more clarity on why they opted for monitoring rather than a biopsy. You can also always ask about your options for a second opinion, or discuss any concerns further to make sure you're comfortable with the plan going forward.
    Remember, you're not alone in this. Many parents have shared similar experiences and concerns, and I hope some others will be here soon to offer their thoughts and advice.
    Wishing you and your little one all the best,
    Renata, Cancer Chat Moderator
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    Hi, sorry you've gone through this. 

    Appreciate your post is from a year ago, but wondering what the outcome was. Did you get a follow up review appointment and were they still happy with the way it was looking at the time, did a biopsy get explored further? I truly hope it turned out positive. 

    We found ourselves in a very similar position. Last year our daughter had a vertical line show on her middle finger just after her 2nd birthday, we were referred to our local hospital who initially had wanted to do a biopsy (we even had a date) it was only when her case was submitted to the specialist paediatric dermatology department at a much larger hospital did we get told they wanted to see her before such a procedure would go ahead. 

    Took a further 2 months for the referral to be seen by two consultants and they both made it clear, due to the rarity of the chances of this, especially with her age no biopsy would be considered and it would be reviewed in 6 months. The line showing was a deep brown line 1mm thick at the time.  We were told for this age group they wouldn't have normally offered a follow-up as the chances of it being anything is so vanishingly rare. But for reassurance we were given a 6 month review. 

    We have just had the 6 month follow up (9 months later) at the big hospital, line is now 2mm thick, my daughter now 3yrs. We were seen by a different consultant (a professor) this time along with one of the original consultants from last year. They both agreed on the rarity of it still and that it would most like be nothing to worry about. However the professor said at this stage because he couldnt offer a 100% conculsion that he was happy with the nail, and said only a biopsy would offer the peace of mind of knowing either way, at this he said the decision for a biopsy was with the parents. He was very honest about what we would be putting our daughter through the pain it would cause her, and the after care, the likelihood of a deformed nail and the up keep of that etc. The other consultant had again offered us a 6 month review. 

    We have decided to go for a biopsy of the nail, and now waiting for the referral back to our hospital and to see the original plastic surgeon who had initially wanted to do the biopsy. Hopefully have a date in the next 3 weeks. 

    Curious of your outcome, as although each consultant we've seen did have a different approach, all of them were echoing the same that the chances of it being anything is super rare, which we are praying is the case 

    Thank you x

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