Beau’s lines (horizontal nail ridges) are primarily caused by temporary disruptions in nail growth due to cancer treatments—specifically chemotherapy and targeted therapies for breast, colon, and other advanced cancers. They are also linked to severe systemic illnesses like lymphoma and can result from nutritional deficiencies or severe infection related to the illness.
Nail changes including discoloration, crumbling, onycholysis, Beau lines, ridging, pitting, thinning, etc., have been described in T-cell lymphomas [1, 2]. Reports of nail changes in B-cell lymphomas and Hodgkin lymphomas are limited. Beau lines are horizontal ridges and indentations that develop on nails.
Chronic conditions that interfere with blood flow to your nail matrix can cause Beau's lines, including:
Subungual melanoma, or nail melanoma, is skin cancer under your nail. It usually appears as a dark, vertical (top to bottom) streak on your nail. Subungual melanoma is rare but serious. This type of skin cancer — called acral lentiginous melanoma — is an aggressive form of melanoma.
Nail Clubbing. Nail clubbing is when your nails appear wider, spongelike or swollen, like an upside-down spoon. Clubbed nails are often a sign of a health condition that needs treatment, such as lung cancer.
Lung cancer often doesn't cause physical symptoms in its early stages, but as it progresses, it can lead to persistent coughing, chest pain, shortness of breath, wheezing and fatigue. Some people may feel hoarseness, pain in the shoulder or back, or experience frequent respiratory infections.
Doing a finger or thumb test for lung cancer can help you spot changes. You can check for the Schamroth sign to see if your fingers have become clubbed. Checking for the Schamroth sign entails placing the nails of both index fingers together up to the last joint as if you're forming the top of a heart shape.
Some fingernail or toenail changes may be a harbinger of a condition called subungual melanoma, commonly known as nail bed cancer, a rare occurrence that accounts for less than 4 percent of all malignant melanomas.
Twenty potential signs of cancer include **unexplained weight loss, persistent fatigue, unusual lumps or swelling, skin changes (sores that don't heal, new moles, color changes), changes in bowel/bladder habits, persistent cough or shortness of breath, hoarseness/voice changes, difficulty swallowing, persistent indigestion, unexplained pain, night sweats, unusual bleeding/bruising, mouth sores that won't heal, loss of appetite, fever, changes in vision/headaches, swelling in lymph nodes, nipple changes, painful urination/ejaculation, and swelling in the face/neck; these warrant a doctor's visit if they last more than a few weeks.
In people with follicular lymphoma, Beau's lines may form due to treatments such as radiation therapy or chemotherapy. They typically appear a few weeks after the treatment that disrupts the nail growth.
Thyroid diseases such as hyperthyroidism or hypothyroidism may cause brittle nails or splitting of the nail bed from the nail plate (onycholysis). Severe illness or surgery may cause horizontal depressions in the nails called Beau lines.
A common side effect of chemotherapy and radiation, multiple Beau's lines will develop with repeated chemotherapy cycles; between treatment cycles, the nails return to normal.
A single Beau's line on one nail may indicate localized trauma. Beau's lines on all nails may signal a systemic condition or prolonged stress. Multiple Beau's lines usually reflect repeated trauma. Deep or thick Beau's lines may indicate chronic illness or long-standing injury.
Common symptoms of having lymphoma include swelling of lymph nodes in your neck, in your armpits or your groin. This is often but not always painless and often could be associated with fevers, or unexplained weight loss, or drenching night sweats, sometimes chills, persistent fatigue.
Warning signs of lymphoma often include painless swelling of lymph nodes (neck, armpit, groin), persistent fatigue, unexplained fever, and drenching night sweats, alongside weight loss, persistent itching, cough, or shortness of breath. Other signs can involve easy bruising, frequent infections, or abdominal pain/swelling, but these symptoms can also signal other conditions, so seeing a doctor for a proper diagnosis is crucial.
When cancer is suspected there is a fast route within the NHS to get further tests and specialist advice to rule out cancer. These are called 2 week wait referrals and you should be seen within 2 weeks of being referred.
Some general signs and symptoms associated with, but not specific to, cancer, include: Fatigue. Lump or area of thickening that can be felt under the skin. Weight changes, including unintended loss or gain.
Silent cancers refer to those cancer types that do not have any noticeable early symptoms, and in such cases, patients may have no symptoms of cancer until the advanced stages. The doctor diagnoses silent cancers, usually in their advanced stages.
Schamroth Window Test
In this test, the person places their two index fingers together, nail to nail, forming a heart shape. There should be a small, diamond-shaped window between the cuticles of the fingers. In people with finger clubbing, the fingers will lie flat against each other and no window is visible.
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The main symptoms of lung cancer include:
Complete blood count (CBC).
A CBC can detect some blood or immune system cancers like leukemia and lymphoma. But it can't detect solid organ cancers like lung, breast or colon cancers.
Finger clubbing is where the appearance of your fingers change, and become more curved or the ends get larger. Clubbing often occurs in heart and lung diseases that reduce the amount of oxygen in the blood, with lung cancer the most common reason for fingers to club.