11 Nov Toe Cancer Killed Bob Marley
In 1981, the world lost the one and only Bob Marley to a rare type of melanoma in his toe at the age of thirty-six. Contra to popular belief, not all skin cancers are caused by Ultraviolet radiation from the sun. Melanoma skin cancer may appear under a finger or toenail, but it is very uncommon.
Brown to black discolouration of a finger or toenail can be caused by several factors. Longitudinal melanonychia describes a pigmented band and is due to melanin within the nail plate (like a freckle or a mole). They are usually benign. The discolouration may be from a bruise or blood under the nail from a major trauma (dropping something heavy on your foot) or minor repetitive trauma (like ill-fitting footwear). Blood trapped under the nail grows out very slowly, whereas the pigment will not. It’s also good to remember that patients with darker skin types may develop multiple brown lines in multiple nails which commonly occurs naturally with aging.
There is a quick checklist that helps us identify any “red flags” for a suspicious lesion:
A: Age >50 years old
B: Brown to black, lots of different colours, blurred borders, breadth >3mm
C: Changes of melanonychia or nail plate, crumbling at the end of the nail
D: Digit: single digit, especially the big toe, thumb and index finger
E: Extension of pigment into nail fold (Hutchinson sign)/skin below the nail
F: Family or personal history of melanoma
A brown longitudinal band (on a single nail) that is widening, has different shades of pigment within it or has spread onto the cuticle are signs that warrant immediate referral to a specialist.
The best thing to do if you are not sure is to keep track of any strange markings under the nail or on the foot with your camera phone. See a Podiatrist for closer inspection and their opinion. If they want to rule out melanoma, they may refer you to a Dermatologist to have it biopsied.
Bob Marley refused treatment, citing religious reasons and the potential impact it could have on his ability to perform. Eventually, he would submit to having a portion of his toe removed, but by then it was too late. Cancer had spread to his brain and vital organs.
Skin checks are so important, don’t wait until it’s too late.
Photo Credit- DermNet New Zealand