ALM can also develop as subungual melanomas under the fingernails or toenails. An early sign of this type of cancer is a dark stripe under the nail, usually the big toe or the thumb. As the streak grows, the nail may crack or break. Doctors may misdiagnose the condition as a fungal infection or a trauma injury, delaying accurate identification. Interestingly, the streaks that appear under the fingernail or toenail of people with darker skin are usually benign but should still be evaluated.

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