When Karolina Jasko's thumbnail became infected, she thought it might be related to dirty tools at her nail salon. She went to the doctor to get it checked out, and that infection ended up potentially saving her thumb, and maybe her life.
The former Miss Illinois, now 21, said she would regularly get her nails done in high school with acrylics and gel polish and go under the UV light to harden the manicure.
When Jasko was a senior in high school, she developed the infection and also noticed a dark vertical line on the same thumb nail. She said she didn't think much about the peculiar line, but wondered what could have caused the infection.
She went to see her doctor about the infected nail, who instead became worried about the dark line.
"So I went to my primary care physician, and as soon as I went to him, he kind of told me that he doesn't want to scare me, but that it sometimes is a sign of melanoma," she said. "And especially with my mom's history, that we should go get it checked out right away."
Melanoma is less common than some other types of skin cancer, but it is more likely to grow and spread, according to the American Cancer Society. It is also one of the deadliest forms.
Jasko's mother battled melanoma twice and recovered. As a result, she said her family had always been on the lookout for any unusual spots on the skin. Melanoma on a nail, however, was something they weren't thinking about.
"My mom had melanoma twice and she didn't know that it was under your nails, you know? Someone who was so well-known and well-educated on melanoma because she had it herself, when it actually came down to her daughter, me, having it, we were very uneducated and we didn't think that that's what it could be," she said. "It's crazy. So how do you expect just a random person off the street to know?"
They were referred to a dermatologist, who right away sent them to see a dermatologist surgeon, who confirmed it was melanoma. The nail infection, which led Jasko to see a doctor in the first place, was unrelated to the skin cancer and it was unclear what caused it, her doctor said.
"To this day, they have no idea what that infection was," she said. "He told me himself, he was like, 'I don't know if you believe in God, but if you do, then thank God because if you didn't get that infection you probably wouldn't have came.'"
Jasko, who was 18 at the time, had three surgeries in total due to her thumbnail continuing to grow back. She no longer has a thumbnail after the whole nail matrix, the area where your fingernails and toenails start to grow, was removed. Doctors used a skin graft from her groin area to cover her thumb.
Her doctors said the fact she had a family history of melanoma meant that she had a greater chance of getting it, and the ultraviolet ray exposure at the nail salon wasn't necessarily the main cause, but could have led it to form earlier.
"The thing that they told me is the fact that I had it in my genetics, there was a chance of me getting it, regardless of (ultaviolet rays) or not," she explained. "So they're not saying that that's what caused it, but they're saying that me having that constant UV ray exposure was probably what could have caused it to come out faster and in that area."
According to the New England Journal of Medicine , a person waits an estimated 2.2 years from the start of their symptoms until diagnosis of subungual melanoma. "Subungual" is the medical term for "under the nail."
Subungual melanoma often starts as a dark streak under a toenail or fingernail, which a person may mistake for a bruise. The thumb, index fingernail and big toe are the most common digits, according to Dr. Dana Stern, Nu Skin's nail health expert and one of the few dermatologists in the country who specialize in nail health and disorders.
Stern, who treats patients for a number of nail-related issues including cancer, infections and inflammatory diseases, believes there is a lack of public knowledge about nail melanoma, which can lead to major delays in diagnosis.
"I treated a young woman in her twenties who had been covering up a nail melanoma with an acrylic nail for years because she thought the nail was ugly," Stern said, who sees patients at her New York offices. "There is definitely a lack of public knowledge about the subject and that is one of the reasons that nail melanoma tends to be diagnosed later than melanomas on the skin."
If you see a dark line on your nail, Stern said there are other causes that don't necessarily mean cancer.
"MOST dark lines on nails are benign," she said in an email. "In fact pigmented bands in the nail are extremely common in many darker pigmented individuals. The melanocytes (pigment producing cells) in the nail are typically dormant (not active) which is why our nails tend to be clear."
However, Stern said when the melanocytes in the nail become stimulated, they begin to produce pigment which appears as a light brown or grey band. These lines are due to benign "melanocytic activation." In other words, the cells are merely "waking up" and doing what they are supposed to do, which is producing pigment, she said.
Melanomas, in contrast, are due to the melanocytes growing in an "uncontrolled fashion," Stern added.
If you notice a new pigmented dark band on your nail, you should see a board-certified dermatologist as soon as possible. Doctors say you should also take precautions when using light boxes during manicures, including applying a physical blocker sunscreen on your hands or wearing protective gloves.
Stern advised that people of all skin types should have an annual exam, noting that melanoma on acral sites, including palms of the hands, soles of the feet, and nails, tends to occur more commonly in darker skinned individuals. Singer Bob Marley died from this form of skin cancer, called acral lentiginous melanoma, in 1981.
As for Jasko, who became Miss Illinois 2018 and competed in the Miss USA pageant, she is now in her third year at the University of Illinois at Chicago and is studying to be a licensed marriage and family therapist. She said her missing thumbnail used to be a source of insecurity for her, but she's grown to appreciate the scar.
"It's crazy because for the longest time I was just so insecure about it and I would still wear a band-aid on it even after it was healed just because I didn't want people to look at it, and now I think back to it and I'm like, 'God that was so dumb.' I should be so happy and I am so happy that this is all that it had to come to, you know? Because it could have been so much worse," she said.
The Illinois native said she still sometimes goes to the nail salon, but gets her nails done with regular polish and without the UV rays.
This story was reported from Los Angeles.