Nails, hands & feet · 12-week guide
Nail & Sole Melanoma Watch
In Black people, melanoma most often starts on the soles, palms and under the nails. It is rare, but found late it is dangerous. A 2-minute monthly check is all it takes.
- Length
- 12-week guide
- For
- Women, Men
- Evidence C
- Expert consensus: sensible care, fewer trials
- What to expect
- Monthly checks for 3 months build the habit for life. A bruise grows out over weeks; a melanoma line does not.
The goal: You know your normal; any worrying change is seen by a doctor early.
The ABCDEF rule is a clinical aid from case series (Grade C). That melanoma in Black people most often starts on the soles, palms and nails, and is often found late, comes from strong population data (US registry, Nigerian series).
Start this program
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The plan
Week 1
First full check
All 20 nails, soles and palms; baseline photos.
Knowing your normal is what makes a change obvious.
Morning
Monthly nail check
In daylight, look at all 20 nails (remove polish or gels first). Photograph any dark line next to a ruler or coin.
Why: A band that is new, widening or changing is the key warning sign.
AAD: Skin cancer in people with darker skin tones — how to find it
Evening
Soles and palms too
Check soles (use a mirror or ask family), between the toes and palms for a dark spot that is growing, has several colours or bleeds, or a sore that will not heal.
Why: Acral melanoma is the commonest melanoma type in Black patients; in a Nigerian series melanoma was the commonest skin cancer, mostly on the foot.
Habits
Know your normal
Many people with brown or black skin have several thin, even, light-brown lines in many nails from early adulthood — usually harmless. What matters is ONE nail that is different, or a line that changes.
Why: Ethnic melanonychia is common and benign in darker skin.
Weeks 2–4
Learn the warning signs
ABCDEF; bruise or melanoma; never cut or burn.
Plain rules help you tell harmless bands from ones a doctor must see.
Morning
ABCDEF warning signs
A — adult (especially over 50). B — band that is brown-black, 3 mm or wider, or has blurred or irregular edges. C — change: widening, darkening, or the nail splitting or lifting. D — digit: thumb, big toe or index finger. E — extension of the colour onto the skin around the nail. F — family or personal history of melanoma. Any one of B, C or E: see a doctor within 2 weeks. Bleeding, a lump under the nail, or a sore that will not heal: see a doctor sooner.
Why: The ABCDEF rule helps tell nail melanoma from harmless bands.
Levit et al. The ABC rule for clinical detection of subungual melanoma (J Am Acad Dermatol, 2000)
Evening
Bruise or melanoma?
A bruise from injury grows out toward the tip over weeks; a melanoma line starts at the base and does not grow out. If unsure, photograph and recheck in 4 weeks — or see a doctor now if colour is on the surrounding skin.
Why: AAD: nail melanoma is often mistaken for a bruise.
AAD: Skin cancer in people with darker skin tones — how to find it
Habits
Do not cut, burn or apply herbs
Never treat a dark spot or nail with blades, caustics or traditional pastes; get it examined (a doctor can look with a dermatoscope and may take a small sample).
Why: Late presentation is common in Nigeria and worsens outcomes.
Oseni et al. Malignant skin lesions in Oshogbo, Nigeria (Pan Afr Med J, 2015)
What a doctor checks
Nail changes such as a dark streak, lifting or a bump under the nail are reasons to see a dermatologist.
Why: AAD lists nail changes a dermatologist should examine.
Week 5
Month 2 check
Repeat the full check; compare photos.
Change over time is the strongest warning sign.
Morning
Gentle nail care
Keep nails clean and trimmed so lines are easy to see.
Why: Polish and gels hide changes.
Monthly check
Monthly nail, sole & palm check
All 20 nails, soles, between toes and palms; compare with last month's photos. Use the ABCDEF signs.
Why: Comparing photos shows widening or new colour.
Levit et al. The ABC rule for clinical detection of subungual melanoma (J Am Acad Dermatol, 2000)
Habits
Know your normal
Several even, thin bands in many nails are usually harmless; one different or changing nail is what matters.
Why: Avoids needless worry while catching real change.
Weeks 6–8
Habit
Quick look when you trim nails.
A habit linked to nail trimming lasts.
Morning
Look when you trim
Each time you trim nails, glance at every nail and both soles.
Why: Ties the check to something you already do.
AAD: Skin cancer in people with darker skin tones — how to find it
Habits
Teach the family
Show older relatives the ABCDEF signs; check the soles of anyone who cannot see their own feet.
Why: Older adults and people with poor eyesight are often diagnosed late.
Oseni et al. Malignant skin lesions in Oshogbo, Nigeria (Pan Afr Med J, 2015)
Week 9
Month 3 check
Full check; set a monthly reminder for life.
Three checks build a habit for life.
Morning
Gentle nail care
Monthly check
Monthly nail, sole & palm check
As before; compare with your first photos.
Why: Change over 2 months is easy to see in photos.
Levit et al. The ABC rule for clinical detection of subungual melanoma (J Am Acad Dermatol, 2000)
Habits
Set a lifelong monthly reminder
Same day each month, for example the first Sunday.
Why: Regular checks catch change early.
AAD: Skin cancer in people with darker skin tones — how to find it
Weeks 10–12
Keep the habit
Monthly checks continue; act on any change.
Early diagnosis is what improves outcomes.
Morning
Look when you trim
Habits
Any B, C or E sign: see a doctor within 2 weeksDoctor or pharmacist
Take your photos. Ask for a dermatologist if possible.
Why: Black patients are more often diagnosed at a late stage; early review changes that.
Milestones
Your weekly check-in
Ask yourself these once a week. If an answer worries you, stop and see a doctor or pharmacist.
Stop and see a doctor if
- Any one of B (band 3 mm or wider, or irregular), C (change) or E (colour on the skin around the nail): see a doctor within 2 weeks
- A nail that bleeds, lifts or splits with a dark line, or a lump under the nail: see a doctor promptly
- A dark spot on a sole or palm that is growing, multi-coloured or bleeding
- A foot sore that will not heal (urgent if you have diabetes)
In an emergency, call 112112999911911.
Sources
- Levit et al. The ABC rule for clinical detection of subungual melanoma (J Am Acad Dermatol, 2000)
- Bradford et al. Acral lentiginous melanoma: incidence and survival patterns in the United States, 1986–2005 (Arch Dermatol, 2009)
- AAD: Skin cancer in people with darker skin tones — how to find it
- Oseni et al. Malignant skin lesions in Oshogbo, Nigeria (Pan Afr Med J, 2015)
- DermNet: Melanonychia
- AAD: Nail changes a dermatologist should examine
Education, not diagnosis. This plan cannot examine you; pending physician review where marked.
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