In November 2021, Grace Garcia visited a new nail salon for a manicure. The nail technician nicked her cuticle and she bled a little. The cut never fully healed properly and she later developed a wart. She learned that she had nail cancer caused by the rare human papillomavirus (HPV).
“She probably used the tool on a previous person. I have no idea,” Garcia, 50, of San Gabriel, Calif., told TODAY.com. thing I had in my hand. … It appeared. It looked like a wart, and I thought, ‘What is that?’ ”
A manicure leads to a months-long problem
Just before Thanksgiving 2021, Garcia visited a nail salon for a manicure. She’s been getting her nails done for about 20 years and couldn’t get an appointment at her usual home. So she scheduled one at a spa near her workplace, which she chose because it looked “chic,” she recalls. During the manicure, the manicurist brushed Garcia’s cuticle on his right ring finger.
“She cut me, and the cut wasn’t just a regular cuticle cut. She cut me deep, and that was one of the first times it happened to me,” Garcia explains. “I been doing (my nails) for years and years and years. I was pissed.” Garcia doesn’t remember if she saw the nail technician opening unused tools, something that still haunts her.
“I don’t remember at all,” she said. “It’s always a great sight when they pull out the tools and open the package, and I don’t remember – and I should have.”
When she got home, she put antibiotic ointment on her cut. After a few days things weren’t getting any better, and she returned to the salon to alert them to their employee’s mistake.
“I was upset and went back, and told them that lady had cut me and my finger was still bothering me,” Garcia says. “They said, ‘Oh, we fired her (after) a lot of complaints. That was it.”
Fearing that the cut would not heal properly, she consulted her doctor, who prescribed an antibiotic for her finger.
“It never got better, but it wasn’t bad. It was strange,” she said.
His finger was tender. If she accidentally hits him against something, it hurts. Eventually, she healed, but a bump that was darker in color than the rest of her skin appeared instead.
Garcia visited her doctor and again asked about it. They thought it was a “writing callus,” but she didn’t really use her ring finger while writing, she recalls. His doctor recommended watching him.
When she saw her gynecologist in April 2022 — five months after the nail appointment — she pointed her finger at the doctor, who suggested Garcia see a dermatologist.
The dermatologist also advised to keep an eye on it. The bump went from a bruise to an open sore and eventually a wart grew. Afterward, Garcia returned to her primary care physician and visited another dermatologist. She underwent a biopsy.
“I knew it wasn’t good,” she said.
Nail cancer caused by HPV
Nail cancers remain rare, and most of them are melanomas, says Dr. Teo Soleymani, a dermatologist at UCLA Health who treated Garcia. In Garcia’s case, she had squamous cell carcinoma, a common skin cancer that is less aggressive than melanoma. But the cause of hers, HPV, is unusual.
“It is quite rare for several reasons. Generally speaking, strains that cause cancer from an HPV perspective tend to be more sexually transmitted,” Soleymani told TODAY.com. “In Grace’s case, she had a wound, which became the gateway. So that thick skin that we have on our hands and feet that acts as a natural barrier against infections and things like that was no longer there, and the virus was able to infect her skin.
Garcia’s cancer grew rapidly.
“Hers was interesting in that her timeline was about three months, which is pretty short for squamous cell carcinoma,” says Soleymani. “It’s also appropriate that she has a high-risk strain of HPV which bodes pretty well because it’s not just a mild cut.”
Through her determination, however, she met Soleymani early and was diagnosed with stage 1 cancer.
“Your results are entirely dictated by how quickly you catch them, and very often they are completely curable,” says Soleymani. “Her perseverance, not only was she able to get a great result, but she probably saved herself from having her finger amputated.”
Soleymani performed Mohs surgery on her, a procedure that allows doctors to see “100% of the edge” of the cancer. This means doctors can remove all of the cancer, providing a “high cure rate” without removing too much skin.
“Because we are able to verify 100% of the margin with the Mohs micrograph technique, it doesn’t need radiation,” says Soleymani. “She doesn’t need any further treatment.”
The most common nail cancers dermatologists see are melanomas, which usually appear as a black or dark brown streak along the length of the nail. If people have squamous cell carcinomas of the nail, they look like a bleeding lump.
“Any time you have a growth that doesn’t go away in about four weeks, that’s kind of our signal,” Soleymani says. “You should see your dermatologist.”
He recommends that everyone get the HPV vaccine to prevent the development of HPV-related cancers.
“The vaccine has been shown in many emerging studies over the past two years to not only reduce the incidence of common things, like warts and obviously cervical cancer, which it’s come out for, but also to reduce the risk and incidence of HPV-related skin cancer,” he says.
life after cancer
As Garcia’s fingernail returns to normal, she still feels traumatized.
“We consider a manicure to be something special,” she says. “And it happens.”
Garcia should follow up with her dermatologist for regular skin cancer screenings. She thinks it’s important to talk about her experience to raise awareness and encourage people who get manicures and pedicures to make sure they watch nail technicians use new tools. She also urges people to be persistent if something is wrong with their health.
“I fought from day one because I knew something was wrong,” Garcia said.