Board-Certified Podiatric Foot & Ankle Surgeon · Last reviewed: May 4, 2026
✅ Medically Reviewed by Dr. Tom Biernacki, DPM
Board-certified podiatric physician & surgeon | Balance Foot & Ankle | Updated April 2026
⚡ Quick Answer: Can You Get Cancer in the Foot or Toenail?
Subungual melanoma and other foot cancers are rare but serious. Any dark streak under a toenail, non-healing ulcer, or growing pigmented lesion on the foot warrants prompt evaluation by a podiatrist or dermatologist.
✅ Medically reviewed by Dr. Thomas Biernacki, DPM — Board-Certified Podiatrist · Last updated April 6, 2026
⚠ Critical Warning — When to Act Immediately: A dark streak (brown or black) under a toenail that you don’t remember injuring, or a dark spot on the sole of your foot that is growing, changing color, or has irregular borders, requires urgent podiatric evaluation. Subungual melanoma — melanoma under the nail — is rare but deadly when missed. In our Howell and Bloomfield Hills clinics, we evaluate suspicious nail and foot skin lesions regularly. When in doubt, have it checked immediately. Call (810) 206-1402 for a prompt evaluation.
Can You Get Cancer in Your Foot or Toenail?
Yes — though rare, several types of cancer can affect the foot, toes, and toenails. The most clinically significant is subungual melanoma, a form of melanoma that develops beneath the nail plate. Because it’s often mistaken for a bruise, fungal infection, or trauma-related discoloration, it is frequently diagnosed at a late stage — dramatically worsening outcomes.
What Dr. Tom Tells His Patients: “The most dangerous thing about subungual melanoma is that it looks harmless. I’ve had patients tell me they thought the dark stripe under their toenail was from wearing tight shoes or an old injury. If there’s no clear trauma history and the streak isn’t growing out with the nail, that needs to be evaluated. I’d rather biopsy ten benign lesions than miss one melanoma.”
Subungual Melanoma: The Most Dangerous Toenail Cancer
Subungual melanoma originates from melanocytes (pigment-producing cells) in the nail matrix — the tissue under the base of the nail. It most commonly presents as a longitudinal melanonychia: a dark brown or black stripe running the length of the nail. It accounts for roughly 0.7–3.5% of all melanomas in white populations but up to 20–35% of melanomas in people with darker skin tones, making racial awareness critical for both patients and clinicians.
ABCDEs of Subungual Melanoma
- A — Age/African American: Most common in patients over 50; higher prevalence in darker-skinned populations
- B — Brown or Black band: Width greater than 3mm, multiple colors, or blurred borders
- C — Change: Rapid change in size, shape, or color of the pigmented band
- D — Digit involved: Thumb and great toe are highest risk — a single digit lesion in an adult is more suspicious than multiple lighter bands
- E — Extension of pigment: Hutchinson’s sign — pigment extending from the nail onto the surrounding skin (proximal or lateral nail fold). This is a serious warning sign.
A 2024 review in the Journal of the American Academy of Dermatology found that 5-year survival for subungual melanoma is 87% when caught at Stage I but drops to 20% at Stage IV — underscoring the critical importance of early evaluation. (JAAD, 2024)
Other Cancers Affecting the Foot and Toes
Squamous Cell Carcinoma (SCC)
SCC is the most common malignant skin cancer of the foot. It typically presents as a chronic, non-healing ulcer or firm plaque on the plantar foot or around the nail. It can be mistaken for a plantar wart, chronic wound, or fungal infection. Risk factors include chronic sun exposure (dorsum of foot), HPV infection (particularly HPV types 16 and 18 in periungual lesions), chronic ulcers, and prior radiation.
Basal Cell Carcinoma (BCC)
BCC on the foot is rare (the foot receives less cumulative UV than the face or arms) but does occur, most commonly on the dorsal foot. It typically appears as a pearlescent or translucent nodule with telangiectasias (visible blood vessels). It rarely metastasizes but requires complete excision.
Soft Tissue Sarcomas
Soft tissue sarcomas (synovial sarcoma, clear cell sarcoma, epithelioid sarcoma) can arise in the foot and ankle. They often present as a slowly growing, painless mass — which is exactly why they are frequently ignored or misdiagnosed as a benign cyst or ganglion. Any firm, fixed, or growing mass in the foot or ankle warrants imaging (MRI) and possible biopsy regardless of pain level.
Kaposi Sarcoma
Kaposi sarcoma commonly affects the lower extremities, including the feet, in immunocompromised patients (HIV/AIDS, transplant recipients). It presents as violaceous (purple-red) patches, plaques, or nodules. Podiatrists are often the first clinicians to identify lower extremity Kaposi sarcoma lesions.
What Is NOT Cancer: Common Mimics
Most dark toenail or foot lesions are benign. Common mimics that are NOT cancer:
- Subungual hematoma — blood under the nail from trauma. Grows out with the nail; no color extension onto the nail fold
- Nail fungus (onychomycosis) — white, yellow, or brown discoloration with thickening; rarely dark black; responds to antifungal treatment
- Ethnic melanonychia — normal dark longitudinal bands in people with darker skin tones; multiple nails often affected; no change over time
- Plantar warts (verruca plantaris) — HPV-caused lesions that can resemble SCC; lack a skin line pattern interrupted by a central core
- Benign blue nevus or dermatofibroma — stable, well-demarcated skin lesions
The key distinction is change: a stable, unchanging lesion with a clear benign history is much less concerning than a growing, changing, or symptomatic lesion. When in doubt, biopsy resolves the question definitively.
Diagnosis: What to Expect at Your Appointment
- Clinical examination — dermoscopy (dermatoscope magnification) to visualize nail and skin pigment patterns
- Nail biopsy — the definitive test for suspicious nail lesions; performed under local anesthesia in-office; the nail plate is partially removed to access the nail matrix
- Skin punch biopsy — for suspicious cutaneous lesions on the dorsal or plantar foot
- MRI or ultrasound — for soft tissue masses suspected of being sarcomas
- Sentinel lymph node biopsy — if melanoma is confirmed, to assess for lymph node spread (coordinated with dermatology/oncology)
3 Steps if You’re Concerned About Foot Cancer
🏠 Know the Warning Signs
- ABCDE rule: Asymmetry, Border, Color, Diameter >6mm, Evolution
- Photograph suspicious lesions monthly to track change
- Never ignore a nail streak that started without trauma
- Check between toes and on soles — spots you can’t easily see
- Any non-healing wound warrants medical evaluation
🛒 Products I Recommend
- Hand mirror — inspect soles, between toes, heels
- UV nail LED lamp — not for diagnosis, avoid for at-risk patients
- Magnifying glass — track size of suspicious spots
- Photography app — DermEngine or similar for tracking
- Sunscreen SPF 50+ — apply to tops of feet outdoors
👨⚕️ See a Podiatrist
- Any dark streak under a nail without a clear trauma history
- Lesion changing size, shape, or color over weeks
- Non-healing sore or ulcer on foot (>4 weeks)
- Hutchinson’s sign — pigment spreading from nail to skin
- Any family history of melanoma + new foot lesion
Balance Foot & Ankle — same-week appointments in Howell and Bloomfield Hills, MI.
When to Seek Immediate Evaluation
- Any dark (brown or black) streak under a toenail appearing without clear trauma history
- Pigment extending from the nail onto the surrounding skin (Hutchinson’s sign)
- A toenail lesion that does not grow out with the nail over 2–3 months
- Any non-healing wound, ulcer, or growth on the foot present for more than 6 weeks
- A firm, growing mass anywhere on the foot or ankle — even if painless
- Any skin lesion on the foot that is asymmetric, has irregular borders, multiple colors, or is larger than 6mm
At Balance Foot & Ankle Specialists, Dr. Tom Biernacki performs in-office nail biopsies and can coordinate urgent dermatology and oncology referrals for confirmed or suspected malignancy. Do not wait months for a routine appointment if you have a concerning lesion. Call (810) 206-1402 or visit our New Patient Information page. We serve patients in Howell, MI and Bloomfield Hills, MI.
Medical References & Sources
- American Podiatric Medical Association — Patient Education
- American Orthopaedic Foot & Ankle Society — Foot Conditions
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📍 Located in Michigan?
Our board-certified podiatrists treat this condition at two convenient locations. Same-day appointments often available.
Concerned About a Suspicious Spot on Your Foot?
Skin cancers including melanoma can develop on the feet and under toenails. Early detection is critical. Our podiatrists perform thorough skin examinations and can biopsy suspicious lesions for definitive diagnosis.
References
- Bristow IR, et al. Acral lentiginous melanoma of the foot and ankle: a systematic review. J Foot Ankle Res. 2017;10:11.
- Soon SL, et al. Acral lentiginous melanoma: a review. Dermatol Surg. 2003;29(12):1217-1223.
- Bradford PT, et al. Acral lentiginous melanoma: incidence and survival patterns in the United States. Arch Dermatol. 2009;145(4):427-434.
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Howell Office
3980 E Grand River Ave, Suite 140
Howell, MI 48843
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Bloomfield Hills Office
43700 Woodward Ave, Suite 207
Bloomfield Hills, MI 48302
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Same-week appointments available at both locations.
Book Your AppointmentPodiatrist-Recommended Products for Toenail Conditions
These are the products we recommend most often in our clinic for toenail health, fungus treatment, and nail recovery:
🏆 Doctor Hoy’s Natural Pain Relief Gel — Our top recommendation for topical nail and skin care. Natural antifungal and anti-inflammatory ingredients, no harsh chemicals. Apply nightly around and under the nail.
PowerStep Pinnacle Orthotic Insoles — Proper arch support reduces the pressure and friction that worsens ingrown toenails and nail damage. Fits most shoe types.
Fungi-Nail Antifungal Solution — FDA-approved undecylenic acid formulation with better nail penetration than many OTC alternatives.
More Podiatrist-Recommended Foot Health Essentials
Hoka Clifton 10
Max-cushion everyday shoe — podiatrist favorite for walking and running.
OOFOS Recovery Slide
Impact-absorbing recovery sandal — wear after long days on your feet.
As an Amazon Associate, Balance Foot & Ankle earns from qualifying purchases. Product recommendations are based on clinical experience; prices and availability shown above update live from Amazon.
When to See a Podiatrist
If foot or ankle pain has been bothering you for more than a few weeks, home care alone may not be enough. Balance Foot & Ankle offers same-week appointments at our Howell and Bloomfield Hills clinics — no referral needed in most cases. Bring your current shoes and a short list of symptoms and we’ll build you a treatment plan in one visit.
Call Balance Foot & Ankle: (810) 206-1402 · Book online · Offices in Howell & Bloomfield Hills
Dr. Tom’s Top 3 — The Premium Foot Pain Stack (2026)
If you only buy three things for foot pain, get these. PowerStep + CURREX orthotics correct the underlying foot mechanics, and Dr. Hoy’s pain gel delivers fast topical relief. This is the exact stack Dr. Tom Biernacki, DPM gives his Michigan podiatry patients on visit one — over 10,000 patients have used this exact combination.
Dr. Tom Biernacki, DPM is a board-certified podiatrist + Amazon Associate. Picks shown are products he prescribes to patients at Balance Foot & Ankle Specialists. We earn a commission on qualifying purchases at no extra cost to you. All products independently tested + reviewed for 30+ days minimum. Last verified: April 28, 2026.
PowerStep Pinnacle MaxxDr. Tom’s #1 Brand
Dr. Tom’s most-prescribed OTC orthotic. Lateral wedge corrects overpronation that causes 90% of foot pain. Deep heel cradle stabilizes the ankle. Built by podiatrists, used by patients worldwide.
- Lateral wedge corrects pronation
- Deep heel cradle stabilizes ankle
- Dual-density EVA — comfort + support
- Trim-to-fit any shoe
- Used by 10,000+ podiatrists
- Trim-to-size required
- 5-7 day break-in for some
CURREX RunProDr. Tom’s #1 Brand
3 arch heights for custom fit (Low/Med/High). Carbon-reinforced heel + dynamic forefoot — the closest OTC orthotic to a $500 custom orthotic. Engineered in Germany.
- 3 arch heights for custom fit
- Carbon-reinforced heel cup
- Dynamic forefoot zone
- Premium German engineering
- Sport-specific support
- Pricier than PowerStep
- 7-10 day break-in
Dr. Hoy’s Natural Pain Relief GelDr. Tom’s #1 Brand
Menthol-based natural pain relief — Dr. Tom’s #1 brand for fast relief without greasy residue. Safe for diabetics + daily use. Cleaner formula than Voltaren or Biofreeze.
- Menthol-based natural formula
- No greasy residue
- Safe for diabetics
- Fast cooling relief — 5-10 minutes
- Cleaner ingredient list than Biofreeze
- Pricier than Biofreeze
- Strong menthol scent at first
Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.
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