What Causes An Unusual Painless Pigmented Spot On The Toenail?

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.



Regards

---

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.

Regards

---