'Cool Streak' on Teen's Thumb Diagnosed As Rare Cancer 10 Years Later

A Virginia woman who developed what she described as a "cool streak" on her thumbnail when she was a teenager was shocked to discover around 10 years later that she actually had a rare form of cancer.

Maria Sylvia, now 25, posted a video on TikTok on March 15, revealing her unusual diagnosis, which ended up going viral—garnering more than 15 million views at the time of writing.

Sylvia, who currently lives in Washington D.C., told Newsweek that she first noticed the streak on her thumb in 2012 when she was 16-years-old.

"It was subtle and I didn't think much of it," she said.

Over the next year, Sylvia noticed the streak growing darker but, at the time, she didn't think that it was anything unusual, jokingly referring to it as her "racing stripe."

While she had seen several doctors for seasonal school sports physicals, Sylvia never mentioned the nail and no physicians noticed until an ingrown toenail prompted her to visit a podiatrist in 2014, when she was 18.

The podiatrist spotted the streak and recommend that she visit a dermatologist. But when she did, the dermatologist told her that she wasn't concerned, given her age and ethnicity.

"The diagnosis was that it was most likely a mole in the nail bed causing the pigmentation streak as the nail grew," Sylvia told Newsweek. "The dermatologist felt there was less than a one percent chance it could be subungual melanoma, so they didn't feel that a biopsy was warranted."

Maria Sylvia and her thumb
Split image showing Maria Sylvia (right) and her thumb affected by subungual melanoma. Maria Sylvia

Subungual melanoma is a rare and potentially serious type of skin cancer that occurs in the skin under the nails of the toes or fingers. According to a 2021 paper, this cancer accounts for only between 0.07 percent and 3.5 percent of melanoma cases worldwide.

However, it is the most common variant of malignant melanoma among African-Americans, Asians, and Hispanics. Figures from the paper show that it accounts for 75 percent of melanomas in African populations, 25 percent in Chinese populations, and 10 percent in Japanese populations, for example.

It also most typically affects women in their 60s and men in their 70s, hence why doctors didn't believe that Sylvia fitted the demographic for this type of cancer.

"The dermatologist advised I keep an eye on it to see if any changes of size or color occurred, but for eight years nothing changed," she said. "Over time, it just became a part of my hand and I just stopped worrying about it."

But in the fall of 2021, a close friend urged her to get a biopsy after reading an article that featured pictures of subungual melanoma cases.

Sylvia eventually underwent the biopsy at a dermatologist's office on January 19, 2022. A few days later, the dermatologist told her that melanoma had been identified in her biopsy sample but it was in its early stages and that she was lucky to have gotten it checked out when she did.

"I remember my heart dropping, and my doctor just went on about next steps," Sylvia said. "I just found out I had cancer in my thumb, and I was overwhelmed by how many appointments I had to make, as well as just having a taste of my own mortality."

A couple of weeks later, Sylvia met with an oncologist who diagnosed her subungual melanoma at stage 0, meaning it had not spread to other parts of the body.

"I was informed that this cancer can stay in situ (also known as stage 0) for 10-13 years before hitting stage 1," she said. I felt relief that I got it looked at when I did, but I knew there was more to come for getting rid of this cancer."

Once it reaches stage 1, this type of cancer becomes very aggressive. The recommended treatment is to remove the cancerous nail bed with surgery.

Eventually, Sylvia was referred to The Johns Hopkins Hospital in Baltimore, Maryland, where surgeons removed the entire nail bed and top of her thumb down to the bone and tendon on March 11, 2022.

Tests subsequently revealed that the cancer had not spread and Sylvia would not need to have her thumb amputated or undergo further treatment. After being given the all-clear, she received a skin graft on March 25.

"From what I know, my thumb should no longer have cancer, but I will have to continue seeing my oncologist and dermatologist every three months for the next two years, and then every six months for the remaining three years since I am now deemed at high risk for having skin cancer," she said. "Overall, I am extremely lucky that this was my prognosis."

Maria Sylvia TikTok melanoma cancer
A photo of Sylvia's thumb taken in 2012 when the line first appeared. Maria Sylvia

After posting the TikTok video on March 15, Sylvia said she never expected such a large response, commenting that it was "so strange" to see thousands of notifications every time she opened the app.

"Overall, the reaction I received was positive and encouraging but I believe it also raised anxiety in some. Before this diagnosis, I was unaware that pigmentation streaks on fingernails of people of color was a common hereditary characteristic," she said. "With that in mind, tens of thousands of comments are from people who have streaks on their fingernails and are worried they might have melanoma."

She said: "I caused quite a bit of panic unintentionally. My mentions were flooded with people flashing their toes and fingers with streaks on them, asking me if they have melanoma too. While I tried to calm them down, I obviously told them to see a dermatologist because I'm not a doctor, and it's better to be safe than sorry."

Sylvia said she had also received numerous comments from people who had lost loved ones to this cancer and were happy that awareness was being raised about it.

"Many stories involved the disregarding of the streaks until it was too late, and the cancer had metastasized even after an amputation," she said. "I have also received comments from survivors of this type of melanoma, who were either like me and had the nail bed removed or who didn't catch it early enough and lost a finger and/or toe."

"They are very grateful for my video bringing attention to early detection as well. I've seen numerous comments of people saying they've made dermatologist appointments."

Sylvia said she was "very grateful" to the friend who pushed her to get a biopsy of the streak.

"The best thing from this video going viral is that hopefully others will do the same if they observe a nail streak on someone they encounter."

Some people who commented on the video, meanwhile, said they had similar streaks in their nails but were afraid to see a doctor.

"I think some people are afraid to confront the possibility of having cancer and facing their mortality," she said. "The biggest thing I have urged is to put your mind at ease and follow through with seeing someone. If this is caught early, it is very curable and having a wonky thumb for a month or two is better than not having one at all."

Sylvia said: "I suppose I could have insisted they biopsy the nail bed years ago to be certain, but I was young, naïve, and comforted by the confidence of the doctors who were basing my case on demographics and statistics. You are taught to trust doctors and their judgments, but this should be a lesson to not play Vegas odds when the one percent result can be lethal. I should have stuck up for myself more."