• Tue, Oct 26 2010

My Toenail Bruise Isn’t Melanoma! Health and Life Lessons From My Foot Doctor

My beautifully drained toenail bruise, after Dr. Bruce Lashley's skillful procedure

Thanks to the mysterious bruise under my left big toenail, over the past week I’ve learned more about podiatry, acral lentiginous melanoma, and Bob Marley than I’d ever thought possible. That’s because my esteemed foot doctor, Dr. Bruce Lashley, was concerned that said bruise might actually be the nasty acral lentiginous kind that killed the Buffalo Soldier. This type of melanoma under the nails, on the soles of the feet, and palms of the hands is, along with behind the eyes, the most common place for melanoma to appear. Wait, but what about skin cancer, you ask? Turns out, that’s much more often basal cell or squamous cell cancer, not melanoma. (I asked Dr. Lashley the same question. I knew there was a reason I didn’t apply to  medical school.) The Bob Marley kind of melanoma doesn’t lead to anything good: Depending on when it’s caught, you’re basically looking at amputation, chemotherapy, death — or a combination of all three. Did I mention I didn’t sleep much this week?

While I wasn’t sleeping, I read plenty of statistics about acral lentiginous melanoma: It’s much less common in younger Caucasians (me), and much more common (yet less easier to spot) in Asians and Black ethnic groups (Marley). This offered a modicum of comfort, but then again, stats are just stats. Then I unwisely typed in acral lentiginous melanoma into Google Images. True, none of the terrifying and nauseating pictures really resembled my bruise, but somehow that comfort left me pretty cold.

So after spending a week trying to convince myself that hopefully I didn’t have Stage 4 melanoma that had spread to my lymph nodes, lungs, and brain (not to mention making up a few weak “Toe Jamming” refrains), this morning I showed up at Dr. Lashley’s office. I was nervous and sweaty about two things: 1. Being told that I have cancer, and 2. To a lesser extent, wondering just how much it was going to hurt to have a hole cut into your toenail without any anesthesia. But the deft Dr. Lashley assured me that he was going to make the procedure as painless as possible, and damned if he didn’t. (I have no idea how he managed this.) He used a few tools to create a small opening near the base of my toenail, just above the bruise. My dear doc also talked me through the whole thing (which only took about ten minutes), and included tales of when, as a six-year-old boy, he accidentally dropped a cinderblock on his big toe, and the doctor on duty drove into his nail with a hot poker. I was beyond grateful that he wasn’t taking out his childhood trauma on me — what I felt was akin to the pinprick of getting a shot or giving blood.

Speaking of blood, once Dr. Lashley saw quite a bit dripping from the hole, he confidentally announced that this bruise wasn’t melanoma at all, but just a pocket of trapped blood. Had it been melanoma, the dark spot would have remained, and I would’ve required a biopsy. In my case, the dark spot was dripping onto his gauze pads. No biopsy, no cancer. Enormous relief.

As I mentioned in last week’s post, I’m not a hypochondriac, but I’m also not afraid to go to the doctor when I feel like something might be wrong. (Thank you, health insurance.) So why did I wait five, six (okay, maybe seven) months after first noticing a bruise under my toenail to get it checked out by a professional? Well, first of all, the bruise was relatively small. I would investigate it in the shower. The nail was growing, so I kept waiting for the bruise to eventually grow out with it and disappear. Also, if we went to the doctor every single time we had a bruise or a stomachache or a twinge in our back or a sore throat, we’d all live in our doctors’ waiting rooms, which would get weird and expensive. Secondly, as far as I could tell, my bruise wasn’t changing or growing, which I took to be a good sign. After all, isn’t change in appearance something to look out for in addition to the ABCDs of skin cancer? (assymetry, border irregularity, color, and diameter).

The answer to that is yes, but as Dr. Lashley pointed out, there are always exceptions to this rule. He told me that, in his day, he’s seen many cases of melanoma that don’t fit the profile. Gulp. My toenail could’ve been that exception. Luckily for me, it wasn’t. Okay, so I’m really glad I finally went to see my podiatrist. Next time, I won’t wait. And my advice to you is not to wait, either. Even if you think you’re being silly. I return to Dr. Lashley in three months for a follow-up visit, and you can be damn sure I won’t be missing that appointment.

Immediately after leaving Dr. Lashley’s office, I skipped over (no pain!) to a nearby coffee place to treat myself to a large latte before heading to my office. Then I called my husband at work. He picked up. “So, I’m probably not going to die like Bob Marley, at least not right now,” I said. “You mean rich, famous, and legendary?” my husband chided. “Exactly,” was my ecstatic, cancer-free reply.

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  • Amanda Ernst

    I had a mole removed from the bottom of my foot earlier this year that my doctor worried me about. It was light in color and I had had it for years and never thought anything about it. It turned out to be harmless (even a podiatrist I had been seeing for years hadn’t noticed it) but I’ll never look at a mole on the soles of my feet the same way again!

    Now, the back of the eyes — that’s scary.

  • Anonymous

    I have an appointment with my doctor tomorrow for an evaluation. I usually keep my toes painted, so I didn’t notice until my pedicure polish started growing out with my nail. It’s been like this for at least a month, but I figured I just stubbed my toe on something and didn’t remember. It doesn’t hurt, and it’s irregularly shaped…I’m very nervous about the outcome as my mother is going through cancer treatment right now and I just don’t think our family can handle this. I’m glad everything worked out for you and I can only hope I get the same results. Cheers!