Shock Diagnosis: Brown Streak On 45-Year-Old Mom’s Fingernail Turned Out To Be Rare Melanoma

Koltcz, a middle school teacher, admitted to putting the odd mark “on the back burner” due to her busy schedule, adding, “I think a lot of people in similar situations tend to put others first, and I just let it go for a while.”

Referring to her diagnosis, she continued, “When you think about melanoma, moles and other spots on your skin come to mind – but who would think to check their nails.

“If you put nail polish over it, you can’t see it – out of sight, out of mind.”

Koltcz noted how the line started out as thin but then became thicker and didn’t go away.

The mom and TikTok user said that a video she watched on social media, of a dermatologist warning about melanoma signs on nails, prompted her to get checked.

“She was showing something that looked exactly like what was under my nail, so I immediately made an appointment with a dermatologist,” Koltcz told Cleveland Clinic.

Koltcz ended up having her nail removed and the area with the odd marking biopsied, confirming she had subungual melanoma, a rare type of skin cancer in March..

Thankfully, her melanoma was caught as stage zero and was able to be surgically removed. She now has no evidence of the disease, and is grateful she didn’t need to undergo further treatment, like chemotherapy or radiation.

“I just kept thinking, ‘How lucky am I that I caught it in time and had such great doctors to treat it,'” she said

Now, cancer-free, Koltcz hopes to raise awareness for melanoma and inform others it can show up in nails.

Koltcz, who also will continue with her routine skin checks, concluded, “My message is for all the parents and anyone who’s out there running this race of a life: You have to take time to take care of yourself, because if you don’t, who’s going to care for the people you love if you’re not here?

“Don’t put off any symptoms or skip out on your annual exams.”

RELATED: Myth Busting: My Fingernails Have Streaks. Do I Have Cancer?

Learning More About Melanoma

Melanoma is the most dangerous form of skin cancer. It starts in the same cells that give your skin, hair, and eyes their color. In melanoma, the cells change in a way that allows them to spread to other organs.

Changes to a mole you’ve had for a while or a new growth on your skin could be signs of melanoma, according to SurvivorNet’s experts. You’ll want to watch them and tell your doctor about any changes you notice.

WATCH: How do you perform a skin check using the ABCDEs?

You’re most likely to find melanoma on sun-exposed skin areas like your face, neck, arms, and legs. Surprisingly, you might also find them in other places as well, like:

• The palms of your hands or soles of your feet
• On your eyes or mouth
• Under your nails

SurvivorNet experts recommend avoiding unprotected sun exposure because ultraviolet (UV) radiation can lead to melanoma. Tanning beds pose ultraviolet radiation risks for skin cancer and should be avoided. Many dermatologists recommend using spray tans to reduce the risk of melanoma skin cancer.

What to Look for When Checking Your Nails for Cancer

When it comes to examining yourself for skin cancer, it’s natural (and obvious) to check your skin and moles. But check your finger and toenails for signs of skin cancer, too.

When checking your nails for melanoma skin cancer, look for the following indicators:

• Dark streak: This could look like a brown or black band in the nail, according to the American Academy of Dermatology, oftentimes on the thumb or big toe of your dominant hand or foot. But a dark streak can show up on any nail.
• Dark skin next to your nail: When the skin around your nail becomes darker, it could be a sign of advanced melanoma.
• Nail lifting from your fingers or toes: When this happens, your nail starts to separate from the nail bed; the white free edge at the top of your nail will start to look longer as the nail lifts.
• Nail splitting
• Nodule or bump under your nails: It’s possible that you could also see a band of color on your nail; it could be wide and irregular, or dark and narrow.

RELATED: Get Your Moles Evaluated to Rule Out Melanoma

Dr. Dendy Engelman, a board-certified dermatologic surgeon and associate at Manhattan Dermatology and Cosmetic Surgery, previously told SurvivorNet it’s also possible that getting your nails done at the salon could increase skin cancer risk.

“The reality is, if we have our hands or feet under these ultraviolet lamps without protection, we’re exposing the dorsum of the hands or foot, the skin around the nails, to this UV light,” she said. “That, over time, can increase our risk of skin cancer.”

RELATED: Myth Busting: My Fingernails Have Streaks … Do I Have Cancer?

Nail Color Isn’t Itself an Indication of Melanoma or Other Skin Cancers

If you see one or any of these indications of skin cancer when examining your nails, don’t jump to the conclusion that you have cancer. (But Dr. Engelman noted that any pigmented streaking of the fingernail should be evaluated by a doctor.)

“Subungual melanoma is a rare and often deadly type of melanoma,” Dr. Engelman said. “This specific type of melanoma that occurs under the nail has fairly classic clinical findings with linear, darkly pigmented streaking of the nail and involvement of proximal nail fold or cuticle.”

However, Dr. Engelman added, nail color isn’t itself an indication of subungual melanoma, nor a reason to believe you may have other types of melanoma.

“Determining one’s risk factor for melanoma solely on the color of the nail plate is neither helpful nor vetted in science,” she said. “There are many causative factors that can lead to discoloration in the nail. Melanoma of the nail does not mean nor predict that you will have melanoma elsewhere on the body, either.”

So, while some fingernails streaks may be a sign of this one specific type of melanoma, fingernails aren’t an indicator of overall skin health. It’s important to be alert for other signs and symptoms, too, and get regular checks by your dermatologist.

Melanoma Treatment Options

Melanoma treatment has come a long way. Survival rates have risen dramatically, thanks to a “treatment revolution,” say SurvivorNet’s experts. With breakthrough treatments like targeted therapy and immunotherapy now available, people who are diagnosed today have a much better chance of living a long and healthy life than ever before.

If you’re diagnosed with melanoma, there’s a good chance surgery is going to be the treatment your doctor recommends. In the early stages of the disease, removing the cancer should lead to a cure. The question is typically not whether you’ll get surgery, but which kind you’ll have.

WATCH: Dermatologic Surgeon Dr. Nima Gharavi, On The “Gold Standard Treatment” For Melanoma

For an early-stage melanoma that is close to the skin surface, Mohs surgery might be an option. This technique removes skin cancer, layer by layer, until all the cancer is gone.

In general, stage I melanoma surgery consists of the simple, in-office removal of the cancerous cells by a dermatologist. If the cancer is thicker, your surgeon will remove it through a technique called wide excision surgery.

The removal of stage II and III melanomas are performed by surgeons or surgical oncologists, not dermatologists. You may also have a sentinel lymph node biopsy to see if the melanoma has spread to the first lymph node where it’s most likely to travel. If your cancer has reached this first lymph node, it may have spread to other neighboring lymph nodes, and possibly to other organs. Where the cancer is will dictate your treatment.

After surgery, the removed tissue and lymph nodes will go to a specialist called a pathologist, who will measure the melanoma and find out if it has clear margins. Having clear margins means the cells around the area of tissue that was removed don’t contain any melanoma. When there aren’t any cancer cells left around the removed area, your cancer is less likely to come back.

Once your cancer spreads, treatment gets a little more complicated, but there are still ways to stop it. New treatments have vastly improved the outlook for people with metastatic, or stage IV, melanoma.

Targeted drugs and immunotherapy have been shown to be more effective than chemotherapy. So, with many more choices, there is no standard treatment. Treatment will vary based on your condition and whether there is recurrent disease.

Research has found that immunotherapy drugs such as Keytruda (pembrolizumab) and Opdivo (nivolumab) helped some people live longer. Combining immunotherapy drugs Yervoy (ipilimumab) and Opdivo (nivolumab) has also extended survival. Opdivo (nivolumab) + relatlimab is a new therapy option added to the National Comprehensive Cancer Network guidelines in 2022.  The combination of two immunotherapies is called Opdualag.

For those with the BRAF mutation, targeted drugs which shrink or slow the tumor can be a good option. This could include a combination of drugs, such as:

• Zelboraf (vemurafenib) and Cotellic (cobimetinib)
• Braftovi (encorafenib) and Mektovi (binimetinib)
• Tafinlar (dabrafenib) and Mekinist (trametinib)
• Zelboraf (vemurafenib) and Cotellic (cobimetinib) can also be combined with atezolizumab.

“Every patient is different and every situation is different,” says Dr. Anna Pavlick, medical oncologist at Weill Cornell Medicine. She emphasized that “there is no cookie-cutter recipe,” for treating stage IV melanoma.

Dr. Pavlick also notes the importance of personalized care and treatment. “It really is a matter of looking at the tools we have so that we can pick the right tools to give the patient the best outcome.”

So, while there is no one-size-fits-all approach to treating metastatic melanoma, your doctor will work with you to develop a treatment plan that is tailored to your individual situation. Advances in research and technology are making the fight against metastatic melanoma more hopeful than ever.

Contributing: SurvivorNet Staff

Learn more about SurvivorNet's rigorous medical review process.

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