Melanoma of the nail unit represents only 0.7% to 3.5% of all melanoma diagnoses but is associated with a high mortality rate due to late stage at presentation.1 In a recent study of nail technicians’ understanding of presenting signs of nail melanoma, 83% reported learning about nail diseases in their training2; however, the depth of education on nail disorders in nail technician curricula has not been investigated. To further understand their knowledge base, we reviewed cosmetology school curricula regarding nail melanoma and melanonychia.
We spoke with 16 cosmetology schools in Michigan to inquire about the educational resources used in their nail technician training programs. Although students receive both theoretical (textbook, lecture, and exams) and practical instruction, nail pathology training was predominantly based on textbooks. The following 2 textbook series were used: Milady Standard Cosmetology, 14th edition,3 (n = 13) and Pivot Point cosmetology series, 1st edition4 (Salon Fundamentals and Fundamentals Cosmetology) (n = 3). The first book dedicated 13 pages to nail diseases in which 1 paragraph discussed melanonychia and 2 paragraphs reviewed nail melanoma.3 We were quite pleased to find this text accurately noted that nail melanoma most often arises in the nail matrix; has single digit involvement most common on the thumb or hallux; has differential diagnosis, including subungual hematoma; is more often seen in adults with darker skin; needs to be referred to a doctor for biopsy; and has risk of metastasis if untreated.1,3,5 The photo provided is a broad dark brown band with distal aspect of the nail plate splitting, consistent with the concerning features of nail melanoma.3,5 Unfortunately, of the 2 photos provided as examples of benign melanonychia, 1 shows a dark brown band in the skin of a person of color with a broader band at the proximal aspect of the nailfold–an ominous sign of expanding melanocytic lesion,3,5 which is a concerning feature of nail melanoma.
The other textbook series dedicated 17 pages to nail diseases, with 2 paragraphs discussing melanonychia but no mention of nail melanoma.4 This text notes etiologies for melanonychia that include racial background, trauma, medications, and systemic disease, and suggests that in clients with darker skin it is “harmless and service should be performed as usual.”4 It does note that clients with lighter skin and melanonychia should see a physician to rule out serious health concerns; however, after making the client aware, nail service should still be performed as scheduled.4 Unfortunately, the same photo, with broader proximal pigment, is used as 1 of 2 examples of benign melanonychia.4 Although we do not expect nail technicians to be experts in nail disease, we believe that this information is overly simplified and gives false reassurance.
Review of nail technician educational material provides insight for dermatologists, particularly those who specialize in nail disorders. Our investigation was limited to cosmetology schools in Michigan who reported using English-based texts. We acknowledge that the nail technician workforce is diverse and other sources are likely used. Knowing what is being taught allows for potential education and collaboration with the cosmetology industry to screen for nail melanoma, reach these patients earlier, and decrease morbidity and mortality for this patient population.
Conflicts of interest
None disclosed.
Footnotes
Funding sources: Supported by the Department of Dermatology, University of Michigan.
References
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