Raising Awareness About Nail Melanoma

Terri Rodriguez knew about her increased risk of having nail fungus. The 76-year-old Sugar Land resident remembers that her mother and her brother had battled with nail fungus several times. So, when she saw a dark mark on the bottom of her toenail on her right big toe, she figured it was a fungus. She thought she’d get medication to treat it, and the fungus would go away.

At a visit to an orthopedic surgeon to examine bunions on her feet, Rodriguez was prescribed a one-month supply of an antifungal medication. When the costly medication ran out, she didn’t refill it. Then, at her annual physical with her primary care physician in December 2025, the doctor took note of her toe and referred her to a dermatologist.

By the time she went to the dermatologist the following month, her toe had gotten worse. “It was peeling, cracking and it looked different,” she recalls. The dermatologist did a biopsy by taking several clippings of her nail. Her results came back. Rodriguez was diagnosed with subungual melanoma, a rare cancer under her toenail.

“I had never heard of this type of cancer,” Rodriguez explains. “My friends couldn’t believe it either. None of them had ever heard of it.”

Rodriguez says she had always been cautious about sun exposure, wearing a hat and covering her skin with clothing to protect it. She had taken all the precautions. “It was a big surprise,” she says.

Her dermatologist referred her to Casey Duncan, MD, an associate professor of surgical oncology at McGovern Medical School at UTHealth Houston and a surgical oncologist affiliated with Memorial Hermann. Dr. Duncan would determine whether  the melanoma needed to be excised, or removed, for further study and  Rodriguez’s treatment options going forward.

“Subungual melanoma often has a delayed diagnosis,” Dr. Duncan explains. “People think it’s a fungus or a bruised nail and don’t seek care. That can be dangerous, as this is cancer and it can, and does, spread.”

Dr. Duncan also notes that melanoma under the nails and on the bottoms of hands and feet are generally not tied to sun exposure and are more common in people with darker skin. Melanoma also can show up inside the mouth, anus, vagina or in other unexposed places, so it’s important to check these areas regularly as well, she advises.

Melanoma treatment requires a wide excision to remove the cancer and to determine the depth of it to see if it has spread. In Rodriguez’s case, Dr. Duncan needed to take 1 centimeter of tissue from around the visible spot, or lesion. “On a toe, a wide excision requires us to amputate the toe,” Dr. Duncan shares. “We also must test the lymph node nearest to the lesion to see if any spread has occurred.”

Lymph nodes help remove impurities from our bodies, and cancer cells found within lymph nodes indicate the cancer may have spread to other parts of the body.

On March 2, 2026, Rodriguez had her toe amputated and a lymph node tested by Dr. Duncan at Memorial Hermann-TMC. Fortunately, the cancer had not spread, and no further treatment was necessary.

“I was relieved,” Rodriguez says. “When you hear ‘cancer,’ you get scared. I was a little worried, but I thought losing a toe is better than not being healthy.”

She credits her faith and her daughter’s survival of breast cancer as her main sources of encouragement in the aftermath of her diagnosis.

While Rodriguez’s prognosis is good, she will undergo follow-up checks at three and six months to check that no new melanomas have developed. She will also be seen regularly by her dermatologist from now on, as she’s now considered high-risk for melanoma.

“I feel like I can do everything,” she reports several weeks after her surgery. “I started walking with my friends again. I’m feeling blessed to pick up where I left off.”