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Dr. Andrew Rynne

Family Physician

Exp 50 years

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What causes an unusual painless pigmented spot on the toenail?

Answered by
Dr. Kakkar S.


Practicing since :2002

Answered : 8298 Questions

Posted on Thu, 12 Jul 2018 in Skin Hair and Nails
Question: I have had this spot on my toenail for about two months now. I don't remember hurting it and it's painless . what could it be ?
Answered by Dr. Kakkar S. 50 minutes later
Brief Answer:
Possibility of subungual pigment

Detailed Answer:
Hello. Thank you.
I am Dr kakkar (Dermatologist and Venereologist). I have noted your concern and I have viewed the image.

I would like to know have you noticed it drifting distally? Has it changed since you first noticed it? A subungual pigmentation due to hematoma may develop after a period of vigorous activity or sport where no trauma may be recollected. Another possibility is that it is a pigmented onychomycosis.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Kakkar S. 15 minutes later
it has not drifted at all. it has stayed in the same spot and it looks the same. I don't really do sports vigorously or anything. it kinda just is hanging out which is why I got concerned.
Answered by Dr. Kakkar S. 13 hours later
Brief Answer:
Unlikely to be a Melanoma

Detailed Answer:
Thank you for the information.
I don't think it is a melanoma. A subungual pigment without any communication to the nail matrix or nail folds is unlikely to be a melanoma because functioning melanocytes are only present either in the nail matrix or nail folds but never in the nail bed. Moreover a melanoma of the nail unit usually presents as a longitudinal band that grows with the nail. The fact that it has not changed or changed minimally for 2 months is actually against a melanoma. I suggest you to wait for another 2-3 months and take closeup photos and measure distal drift with a photographic scale. Another possibility is of course of onychomycosis.

Above answer was peer-reviewed by : Dr. Nagamani Ng

The User accepted the expert's answer

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