Fingernail Changes May Be Clues About Increased Cancer Risk

An NIH study suggests nail abnormalities like white or red bands may signal a gene mutation that increases cancer risk.

Illustration by The Epoch Times, Shutterstock

Those subtle ridges, discolorations, or thickening of your fingernails you’ve been ignoring could be more than just cosmetic nuisances.

A new study shows they may serve as warning signs for a rare genetic disorder that raises the risk of developing several cancers at a young age.

Genetic Predisposition to Cancer

A recent study published in JAMA Dermatology has found that the presence of onychopapillomas, benign nail abnormalities identified by white or red bands along the length of the fingernail, could indicate a rare, inherited disorder called BAP1 tumor predisposition syndrome.

This syndrome is caused by changes in the BAP1 gene, which research suggests functions as a tumor suppressor. People with this mutation are at an increased risk of developing cancers of the skin, eyes, kidneys, and mesothelioma, previously associated with asbestos exposure. These cancers tend to develop at earlier ages than is typical, often grow rapidly, and are more likely to spread.

Not all people with this mutation will develop cancerous tumors, and some may only experience noncancerous skin tumors.

The study looked at 47 participants from 35 families with a BAP1 tumor predisposition syndrome who ranged in age from 13 to 72 years old.

Among these participants, 87.2 percent showed some kind of nail abnormality. These included white streaks or lines (leukonychia), small hemorrhages under the nails (splinter hemorrhages), splitting or layering of the nails (onychoschizia), and thickening of the nails (distal nail hyperkeratosis).

More specifically, 83 percent of the findings were consistent with onychopapillomas. When looking only at participants aged 30 or older, 88 percent had these onychopapillomas.

A biopsy of the nail beds of five participants confirmed the presence of onychopapillomas. Typically, the condition affects only one fingernail, but among those diagnosed with BAP1 tumor predisposition syndrome, about 88 percent had onychopapillomas affecting multiple nails.

“This finding is rarely seen in the general population, and we believe the presence of nail changes that suggest onychopapillomas on multiple nails should prompt consideration of a diagnosis of BAP1 tumor predisposition syndrome,” Dr. Edward Cowen, head of Dermatology Consultation Services at the National Institutes of Health’s (NIH) National Institute of Arthritis and Musculoskeletal and Skin Diseases, said in a press release.

Nail Screening Shows Promise for Early Detection

The researchers suggest that nail screening could be especially valuable for patients with a personal or family history of melanoma or other potentially BAP1-associated malignancies.

Onychopapillomas are uncommon, Dr. Raman Madan, the chief of dermatology at Glen Cove Hospital in New York, told The Epoch Times. Many cases aren’t even reported, he added, “because it is benign.”

The typical treatment involves surgical removal of the tumor, Dr. Madan said. Some doctors will also remove a small part of the nail bed, which is the area under the nail where the nail originates. This is to make sure the bump doesn’t come back. While this is currently the only available treatment, the condition can recur in 20 percent of cases, and the surgery could lead to complications. Researchers are looking into alternative methods, such as laser treatment, which may carry less risk.

Due to the condition’s rarity and the study’s small cohort, “it is hard to draw any major conclusions,” Dr. Madan said, but noting that the results are “convincing.”

Nail Changes That Shouldn’t Be Ignored

Fingernail appearance can indicate various health conditions.

Yellow or greenish nails may signal fungal infections or psoriasis, while white spots could relate to kidney, liver, sinus, or respiratory issues. Blue or purple discoloration could mean poor blood oxygenation, anemia, or chemical exposure.

Nail shape and texture changes, such as clubbing (curved nails and bulging fingertips), can occur with heart and lung diseases, which reduce blood oxygen. Small dents (pitting) may indicate nail psoriasis, often accompanying a psoriatic rash elsewhere.

Slow nail growth can signify hypothyroidism, malnutrition, or medications slowing growth, while brittle nails may indicate zinc deficiency.

However, nail changes aren’t always definitive as a diagnostic tool. Consult a health care professional about unusual nail changes to determine the underlying cause.