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Dr.Sumanth
Dr.Sumanth, Doctor (MD)
Category: Dermatology
Satisfied Customers: 20077
Experience:  Consultant Pediatrician at Kanchi Kamakoti CHILDS Trust Hospital
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Sort of streak on little toe!

Customer Question

Brown sort of streak on little toe!
Submitted: 8 days ago.
Category: Dermatology
Expert:  Dr.Sumanth replied 8 days ago.

Hi...Welcome to Just Answer. I am Dr. Sumanth Amperayani and I am here to help you today. I have 17 years of experience in the field of Medicine at a tertiary care referral hospital.
Skin conditions are always best diagnosed and treated after seeing them directly. May I request you to upload some images please.
Kind regards ***** ***** Sumanth Amperayani

Customer: replied 8 days ago.
Here is a pic!!
Customer: replied 8 days ago.
Here’s another with flash
Expert:  Dr.Sumanth replied 8 days ago.

  1. How long have you had this and has this appeared recently??
  2. Did this start after any injury?
  3. Are there any sensory symptoms like - itching / burning / pain?
  4. Has there been any recent change in color, consistency, surface, margins or diameter?
  5. Are you having multiple moles on the body?
  6. Is there any family history of Melanoma?
  7. Is there any history of exposure to UV radiation, which comes from the sun and from tanning lights and beds?

Customer: replied 8 days ago.
1. Not sure but only recently noticed after taking polish off! Probs no longer than 3 months
2. I have hit my toe numerous times and wore tight shoes which could be a factor but no specific injury! It does look sometimes like a split nail bed!
3. Nope pain if I touch the area but that’s it
4. No that toe has always been quite rough and weird in it’s shape!
5. No multiple moles.
6. No history
7. No history of sunbeds, I use cream regularly etc
Expert:  Dr.Sumanth replied 8 days ago.

I am typing

Expert:  Dr.Sumanth replied 8 days ago.

Thank you for uploading the images for my better understanding.
This is called melanonychia as it has been unchanged.
I will explain further please.
Melanonychia is characterised by brown to black discolouration of a finger or toenail.
Melanonychia is most often benign and arises from a mole. However, a band of brown pigment in a single nail must be examined and investigated with caution, as melanonychia may be the presenting sign of melanoma of the nail.
Melanonychia occurs more commonly in dark-skinned individuals. Studies suggest that nearly all Afro-Caribbeans will develop black-brown pigmentation of the nails by the age of 50. It may also be present in up to 20% of Japanese patients.
White-skinned people are less commonly affected.
Melanonychia can present in individuals of all ages, including children, and affects both sexes equally.
The nail is a hard and translucent structure that is not normally pigmented and is made of the skin protein, keratin.
Pigmentation results from the deposition of melanin by the pigment cells, or melanocytes. These typically lie dormant in the nail matrix where the nail originates. As the melanin is continuously deposited in the keratinocytic cells of the growing nail, a longitudinal streak arises. This is termed longitudinal melanonychia.
Will let you know when it requires evaluation:Age >50 years old, the color is brown to black, blurred borders, breadth >3mm, changes in color/ borders/ shape/ elevation/ texture, extension of pigment into nail fold, family or personal history of melanoma.

This is not amenable to treatment with any creams please.

May I suggest you discuss these with your dermatologist please.

I sincerely ***** ***** I have helped you today!
Is there anything else where I can be of assistance to you in this regard please. We can continue here until you are satisfied, simply use the reply box and let me know.
Kind regards ***** ***** Sumanth Amperayani

Customer: replied 8 days ago.
is this serious?
Expert:  Dr.Sumanth replied 8 days ago.

No as it has not changed and the breadth is < 3mm we can follow it up with serial photographs. The pother possibility is fungal infection of the toe nail.

Customer: replied 8 days ago.
Hang on wait I’ve just taken a clearer pic is this more of a cut rather than melanoma?
Expert:  Dr.Sumanth replied 8 days ago.

Sure

Expert:  Dr.Sumanth replied 8 days ago.

This looks different from the first image on magnification. How apart were they taken?

Customer: replied 8 days ago.
An hour or two! I did remove a bit of the dead nail above and poked it!
Expert:  Dr.Sumanth replied 8 days ago.

Okay, the 2nd image seems to be thinner in pigmentation. I think we can wait.

Customer: replied 8 days ago.
I pushed the nail bed down more which is why it looks thinner!
Customer: replied 8 days ago.
This is what it looks like when not pushed down right now
Expert:  Dr.Sumanth replied 8 days ago.

There are 2 options.

1. Wait for 2 - 4 weeks and then review with comparative images.

2. Going ahead with a biopsy right away.

I would prefer in this order.

Customer: replied 8 days ago.
Does it look like melanoma? As another dermatologist said it looked benign on here.
Expert:  Dr.Sumanth replied 8 days ago.

That is what even I am suggesting to wait.

Customer: replied 8 days ago.
Ok thanks
Expert:  Dr.Sumanth replied 8 days ago.

Is there anything else where I can be of assistance to you in this regard please?