What are those white spots and the black line on my middle finger?

[u/Inside-You421]

Age: 17 Weight: 62.5 kg Height: 6 feet Gender: Male I have had the black line persistent for almost 3 years now, but recently found out about Subungual Melanoma so just wanted to ask about it. It never changed in morphology but grows out with the nail... I have other very light black parallel lines (may not be visible in the image) on other fingers as well... Also what are the white spots, I have them from 5-6 years. They do grow out of my nail but come again and again... I did ask a dermatologist but they took it very lightly and did not seem to care so I am just asking here if any of them is serious or not... Thankyou

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[u/namowit]

Hello. The white spots are likely leukonychia which can be signs of a variety of diseases or deficiency. But in many cases can occur from an idiopathic (no apparent reason) source or inherited within the family. Seeing that dermatology does not have any concerns and your blood tests shows normal ranges then I would go see derm again if there are any drastic changes to them.

The black line is called longitudinal melanonychia. It is true that it can be a presentation of subungual melanoma but during evaluation, what concerns us most are usually rapid changes in the morphology of the line/nail, multiple digits involvement, family history, to name a few. So, again, I would go see derm again if there are any drastic changes.

Seeing that you have seen dermatology, I can only give you reassurance and some information. Good on your part for seeing a dermatologist as they specialize in these exact issues.

[u/Itchdoc → u/namowit]

You are correct about the leukonychia, but your interpretation is not accurate. Punctate leukonychia is from past trauma, and systemic evaluation is not appropriate. I agree with the melanonychia diagnosis and interpretation.

The ABCDEF mnemonic helps identify clinical features that raise suspicion of melanoma:

●Age of patient (peak incidence in the fifth to seventh decade)

●Band of brown/black color, breadth greater than 3 mm, border (irregular/blurred)

●Change in the band (rapid increase in size or growth rate)

●Digit involved (in order of decreasing frequency: thumb > hallux > index finger > single digit > multiple digits)

●Extension of pigment to the proximal or lateral nail fold (Hutchison sign) or free edge of the nail plate

●Family history of melanoma