If you follow me on Instagram, where I’m @jeanettesloan, you may have noticed my recent post about having to take a break from knitting. I posted a cryptic hint which accompanied one of my posts for #thepattinrepeatgame, promising a longer, explanatory post in the future. Well, today, I can happily explain it all.
Like many dark-skinned people, I have a couple of nails on both my hands and feet with slightly dark vertical lines running from cuticle to tip. It looks a bit like very fine pinstripes. In my case, I was accustomed to these markings because, being very much like my late Mum, I was used to seeing them on her toes and the fingers of her precious creative hands. But around two years ago, the nail on my right index finger began darkening, not from the cuticle downwards but the inner side of the finger and moving across the nail. I hadn’t hit or damaged it in any way and what was even more concerning was that it began with a very definite dark line. Now I know what you’re going to say, I shouldn’t have turned to Dr Google for advice, but that’s precisely what I did, wanting to find out if I should or shouldn’t be worried.
I learned about a relatively rare condition called subungual melanoma or cancer of the nail bed. And, given my body’s tendency to produce tumours (remember, I have a history of Hodgkin’s lymphoma, breast cancer and meningiomas), I decided the most sensible thing would be to visit my GP and ask for a referral to a dermatologist.
Fortunately I live in the UK, where the free healthcare delivered by our beloved NHS means I can see a GP within a matter of days and get referred to a dermatologist within weeks. At my first dermatology appointment, I was seen and told there was no need to worry. Or so I thought. Over the next year or so, I watched as the discolouration crept across my finger, and as it grew, the nail developed vertical weaknesses, which caused it to split. I dealt with it by keeping it short and painting my nails with brightly coloured nail varnish when teaching or shooting tutorials for work. Such was the embarrassment of the manky fingernail. I hated it and the worry the ever-darkening state was causing me. So I went back to my GP and asked for another dermatology referral, this time to someone who had seen it in dark skinned patients.
Again the consultant assured me that it was nothing to worry about for ‘people like you with dark skins’. But having previously Googled again (yes, I know), this time using the search term ‘subungual melanoma in dark or non-white skins’, the results were pretty minimal. Most of the available images showed how the condition presents in white skin, so therefore not valid for a pretty hefty percentage of the world’s population. And, well-meaning as my (white) consultant was when she tried to re-assure me, she only decided to refer me for a biopsy when I told her about my health history. And that’s where the two-week knitting break comes into play.
Before I go any further, if you’re squeamish or sensitive, do not, for heaven’s sake, scroll down to the pictures below or Google ‘nail biopsy’ – it’s as unpleasant as it sounds. Just get yourself to the doctor. I was so worked up at the thought of a nail bed cancer diagnosis that I went on to research ‘prosthetic fingers’, tried knitting without using the finger and imagined how I’d continue to work as a right-handed knitwear designer if I had to lose my right index finger – yep, my brain had already gone there.
Come the day of the procedure; I was almost physically sick with nerves. But after a quick mindfulness session in the waiting room, I was met by a lovely nurse called Melissa, who led me into the treatment room. My entire nail was removed under local anaesthetic by my surgeon, Mr Paul Drake, and I was distracted by lots of good knitting chat as Melissa, Jackie, a third nurse (Amanda, I think?) and Mr Drake’s wife are all avid knitters. The procedure was much less painful than I’d imagined, and today I received confirmation that the biopsy shows no evidence of melanoma. It will take about three months for the nail to regrow, but I can keep my manky finger, nail and all. Hooray!
So why have I written this long and rambling blog post? Because when I had pre-biopsy photographs taken, I gave consent for my images to be used in medical journals and / or a teaching setting. I told both the photographer and the dermatologist how difficult it had been to find references that featured non-white skins and learned that despite it being 2021, most of the images found in medical journals are still of white-skinned patients. Since my biopsy showed no sign of subungual melanoma, I’ve no idea what will happen with the images or whether or not they’ll be of use to the medical profession. But I hope this post will help the next non-white person who – like me – wants to know what they may be facing. To understand what is and isn’t normal for them since they may not have access to a GP or a healthcare system like the NHS. The above images show my nail before the biopsy and below you can see how it looks now. Not pretty is it?
It’s just under two weeks since my biopsy, and though my finger may look like a truck has run over it, it’s not too painful, and what’s more, I’m able to knit! So once again, thank you to our amazing NHS and, in particular, the staff of the Dermatology Department at Brighton General Hospital. Unfortunately the NHS website doesn’t have information on this specific type of melanoma – I guess that shows how rare it is – but you can find out more by doing your own online research, or better still contact your own GP. Stay well.
J x
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