Discovering the truth about nail matrix melanomas

Most teachers would think themselves lucky if students paid attention to every minor detail in class, in Adam Delroy’s case it saved his life.

Mr Delroy was working as a Year 8 science teacher at Moreton Bay College, when 13-year-old student Nikita Rosendahl had the notion that an unusual mark on Mr Delroy’s thumbnail could be cancer.

It reminded her of a nail melanoma image that she had seen on a patient education poster while sitting in a doctor’s waiting room.

Nikita immediately shared her observation with the 25-year-old Mr Delroy.

“I walked up to him after class and said, ‘I think that line on your nail is a melanoma’,” Nikita explains.

“In hindsight, I may have had too much confidence and no training in ‘breaking bad news’ because I was very blunt.”

Mr Delroy initially dismissed the idea, but later decided to see a doctor.

“I was sceptical and amazed that Nikita had some idea about what was wrong with my thumb,” Mr Delroy recalls.

“I had seen numerous doctors beforehand, but none could tell me the cause of my nail discolouration.”

The experience prompted Mr Delroy to see a doctor and they referred him to a specialist melanoma centre.

However, the centre’s preferred plastic surgeon had just been in a bike accident, so they sent him on to skin cancer expert, Professor Cliff Rosendahl – Nikita’s dad!

Professor Rosendahl recalls being pleased and proud, but not surprised, when he heard about Nikita’s actions.

“I was also unsurprised that previous doctors were unable to diagnose Mr Delroy, because most would never encounter a nail melanoma,” Professor Rosendahl explains.

“Nail melanomas make up around one per cent of the 17,000 melanomas diagnosed in Australia each year.”

Professor Rosendahl promptly examined the dark brown vertical streaks on Mr Delroy’s nail matrix, which is a plate below the hard nail surface, and told him that it looked consistent with a melanoma.

He then performed a nail matrix biopsy with a local anaesthetic and removed a sample of nail matrix where the tumour was potentially located, before sending it to a medical laboratory for testing.

The lab confirmed that Mr Delroy had a nail matrix melanoma, known as a subungual melanoma.

Mr Delroy had 2 choices – amputate his thumb or have plastic surgery to remove the melanoma, which would also involve a skin graft taken from the forearm.

Mr Delroy chose the latter and the operation was a success.

Fast forward one decade and Mr Delroy is now completing a PhD in education at QUT and helps teach the Bachelor of Health, Sport and Physical Education at the UQ School of Human and Nutrition Sciences.

“Being diagnosed with a melanoma so young has encouraged me to make the most of life,” Mr Delroy says.

“I try to do things because I can and always seek to pay it forward. I was blessed by Nikita and hope I can offer the generous gift that she offered me to others.”

Nikita is now studying an intercalated MD/PhD at UQ and wants to work as a clinician-scientist.

“I’m passionate about cancer research and have loved science and health since I was a kid,” Nikita explains.

“I don’t think this experience inspired my career choice because I always knew that I would work in science and medicine, but I do view it as evidence that I would pursue the field that I am currently studying.”

It is also proof that life’s twists and turns are unpredictable.

A fortnight after Mr Delroy’s operation, Dr Rosendahl diagnosed a 30-year-old woman with a pigmented lesion on her big toenail.

The woman came to see him after hearing from a friend about Dr Rosendahl’s life-changing work with a teacher.

Her friend turned out to be Mr Delroy’s sister, but that’s another story!

“The ratio of nail-matrix melanoma to skin melanoma is around one in 100 and the likelihood of finding 2 in one year is remote, but 2 in 2 weeks is unprecedented in general practice, as far as I know,” Professor Rosendahl says.

“No one knows what causes nail melanomas, but we know it is not the sun because ultra-violet radiation cannot reach the nail matrix.

“Around 50% of cases are associated with previous trauma.

Nail melanomas also occur with the same frequency in all patients, regardless of skin-type.”

Interested in learning about skin cancer research? Find out more about the UQ Master of Medicine (Skin Cancer).