Nail the warning signs: How a nail issue could indicate rare cancer risk syndrome (BAP1)

Although most benign nail issues are harmless, recent studies indicate they might sometimes be associated with a higher risk of specific cancers. A study by scientists at the National Institutes of Health (NIH) found that a harmless nail problem could mean someone has a rare genetic condition called BAP1 tumor predisposition syndrome.

This condition raises the chances of getting cancer in the skin, eyes, kidneys, and chest and abdomen lining. It happens because of changes in the BAP1 gene, which normally helps prevent tumors. The research is published in JAMA Dermatology. Speaking about common benign nail conditions, Dr Sredharan M, Consultant, Surgical Oncology, Manipal Hospital, Goa, says, “These conditions include onychomycosis (fungal nail infections), paronychia (inflammation of the nail fold), leukonychia (white spots on the nails), and nail psoriasis. While these are often treated with topical or systemic therapies, they can sometimes be stubborn and recurrent.”

Dr Sredharan adds that chronic inflammatory states, such as those seen in persistent fungal nail infections or conditions like psoriasis, can create an environment conducive to cellular mutations and cancer development. “Specifically, chronic inflammation can lead to DNA damage, increased cellular turnover, and the release of pro-inflammatory cytokines, all of which can contribute to oncogenesis.”

Conversely, certain rare cancers in the nailbed can mimic chronic benign conditions such as paronychia, pyogenic granuloma, or fungal infections. It is common for such patients to undergo treatment for benign conditions for a long period before being diagnosed with cancer. Additionally, treatments for psoriasis, such as UVA therapy and immunosuppressive medications, may further increase cancer risk.