Ask the Pharmacist

Q. I just had an appointment with my doctor who was concerned that a spot underneath my toenail might be melanoma and removed the toenail to take a biopsy. Is it truly possible to show up under a nail?

A. Though most people think of melanoma appearing on an area of our body that is frequently exposed to the sun, it is possible, although it is more uncommon, for it to appear in unusual locations such as underneath your toenail.

According to statistics, 86% of melanomas are due to overexposure to the ultraviolet light. This is often a result of sunburns experienced in our youth but also from exposure to tanning beds. Before we delve further into this topic, let’s refresh ourselves with what melanoma is.

Melanoma is a type of skin cancer that begins in the melanocyte cells of the skin. These melanocytes produce melanin found in the bottom layer of the skin’s epidermis, the middle layer of the eye along with other areas and is primarily responsible for the colour of our skin, eyes and hair. These melanocytes can unite together and may manifest into moles (bumps or flat spots on the skin that are usually pink, tan or brown in colour) of which many of us have a few on our body. Moles are benign, meaning they are non-cancerous, but a change to the melanocytes (often due to the changes in DNA from the UV exposure) could result in them becoming melanoma skin cancer. One of the first indicators is a change in colour, size or shape of a mole or an irregular looking new mole.

Our society loves acronyms/rules to remember key information and not surprisingly there is an ABCDE rule for common signs and symptoms to watch out for;

· Asymmetry – one half does not have the same size or shape as the other

· Border -irregular/uneven edge of a border

· Colour – the colour of the mole is not the same throughout and range from pink to dark brown

· Diameter – the size of the mole is larger than 6mm (1/4 inch)

· Evolving – any change to the appearance of a mole such as colour, size, shape or feel

Other important clues to watch for are sores that do not heal, a mole that bleeds/oozes.

The prognosis of melanoma skin cancer can be optimistic if it is discovered and treated early. However, it is impossible to get treatment if you do not know you have it so the most important step you could do for yourself is to check your skin regularly for changes. Only 30% of melanoma cases begin in existing moles which means that most of them just appear as a new mole. This makes it more crucial for you to be in touch with your body and pay attention to any changes. Don’t be shy, get yourself into your birthday suit (get naked) and examine yourself in front of a mirror in a well-lit room at the following body parts;

– your right and left sides of your body and raise your arms to look underneath
– hands, fingers, between fingers and fingernails
– front, back and sides of the legs
– both top and soles of feet and toenails
– genital area and between buttocks
– face, neck, back of neck and scalp with the use of a second hand-held mirror and comb

If you are able, have someone help you examine body parts you are unable to check yourself. As you can see, some of these body parts are unusual spots to look for melanoma. They have termed them Hidden Melanomas due to their ability to go unnoticed for a long period of time.

As described above, one of the Hidden Melanomas is called Acral-lentiginous melanoma and can be found under either a finger or toe nail but it could also be found on the palms of the hand or soles of the feet. Another Hidden Melanoma is called Mucosal Melanoma and can be found, albeit not easily, in the mouth, digestive tract, urinary tract and the vagina. Ocular Melanoma is yet another Hidden Melanoma and is found in the eye. To reiterate, it is important to be in tune with your body so that you may discover unusual changes and act upon them quickly. The sooner melanoma is discovered, the less likely it will be given the chance to metastasize to other body parts.

As with many health conditions, prevention is key. Adhering to the following suggestions will help to reduce your risk of developing melanoma and other skin conditions;

– avoid the sun and look for shade during the peak hours between 10am and 4pm
– do not use tanning beds and opt for a cosmetic tan instead or better yet, be happy with your natural shade of skin
– wear wide-brimmed hats, sunglasses, long-sleeved shirts and pants
– apply a lotion with SPF 30 or higher and don’t forget to reapply every 1.5 to 2 hours, especially after swimming and/or sweating
– apply a lip balm with SPF to your lips

Though your food choices may not directly impact your risk of developing melanoma, the American Cancer Society suggests that a plant-based diet is superior to an animal-based diet to help reduce our risk of cancers overall due to their nutritional value they provide along with the higher fibre content and lower cholesterol levels. Some other diet options to consider are to;

– drink tea daily since the polyphenols found in tea can help improve your immune system

– eat plenty of vegetables since that has been linked to a prevention of cutaneous (invasive) melanoma

 On a side note, there are not many, if any, health reasons that discourage vegetable consumption so make sure at least half of your plate consists of vegetables. Your body will thank you. By the way, french fries do not count as a vegetable.

– Incorporating a weekly fish intake for those who decide not to delve fully into a plant-based diet. It appears that those who ate fish once weekly had a reduced risk of skin disease compared to those who did not.

For more information on this or any other health topic, contact your pharmacist.