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 quite healed properly, and she later developed a wart. She learned that she had nail cancer caused by human papillomavirus (HPV), a rare phenomenon.
“She probably used the tool on a previous person. I have no idea,” Garcia, 50, of San Gabriel, California, tells TODAY.com. “It sprouted, whatever the thing was on my hand. ... It popped up. It looked like a wart, and I’m like, 'What in the world is this?'”
A manicure leads to months-long problem
Right before Thanksgiving 2021, Garcia visited a nail salon for a manicure. She has been getting her nails done for about 20 years and couldn’t get an appointment at her regular place. So, she scheduled one at a spa near her workplace, which she selected because it looked “fancy,” she recalled. During the manicure, the manicurist grazed Garcia’s cuticle on her 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 that happened to me,” Garcia explains. “I’ve been doing (my nails) for years and years and years. I was upset.” Garcia cannot recall if she saw the nail technician open unused tools, something that still haunts her.
“I don’t remember that at all,” she says. “That’s always a big spectacle when they take out the tools, and they open the packet, and I don’t remember that — and I should have.”
When she returned home, she put antibiotic ointment on her cut. After a few days, it wasn’t better, and she returned to the salon to alert them to their employee’s mistake.
“I was upset and I went back, and I told them that lady cut me, and my finger is still bothering me,” Garcia says. “They said, ‘Oh we fired her (after) a lot of complaints.' That was it.”
Worried that the cut wasn’t healing properly, she visited her doctor, who prescribed an antibiotic for her finger.
“It just never got better, but it wasn’t bad. It was strange,” she says.
Her finger felt tender. If she accidentally hit it against something, it hurt. Eventually the healed, but a bump that was darker in color than the rest of her skin popped up instead.
Garcia visited her doctor and asked about it again. They thought it was a “callus from writing,” but she didn’t really use her ring finger while writing, she recalls. Her doctor recommended watching it.
When she saw her gynecologist in April 2022 — five months after the nail appointment — she showed her finger to the doctor, who suggested Garcia visit a dermatologist.
The dermatologist also advised just keeping an eye on it. The bump went from looking like a bruise to more of an open wound and eventually a wart developed. Then, Garcia went back to her primary care doctor and visited another dermatologist. She underwent a biopsy.
“I knew it wasn’t good,” she says.
HPV-caused nail cancer
Nail cancers remain uncommon, and most of them are melanomas, Dr. Teo Soleymani, a dermatologist at UCLA Health who treated Garcia, says. In Garcia’s case, she had a squamous cell carcinoma, a common skin cancer that’s less aggressive than a melanoma. But the cause of hers, HPV, is unusual.
“It’s pretty rare for several reasons. Generally speaking, the strains that cause cancer from an HPV standpoint tend to be more sexually transmitted,” Soleymani tells TODAY.com. “In Grace’s case, she had an injury, which became the portal of entry. 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 the case, and the virus was able to infect her skin.”
Garcia’s cancer developed rapidly.
“Hers was interesting in that her timeline was about three months, which is pretty short of squamous cell carcinoma,” Soleymani explains. "It also fits that she had a high-risk strain of HPV that bodes pretty well with this not just being a benign cut."
Thanks to her determination, though, she met with Soleymani early and was diagnosed with stage 1 cancer.
“Your outcomes are entirely dictated by how early you catch them, and very often they’re completely curable,” Soleymani says. “Her persistence, not only was she able to have a great outcome, 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. That means doctors can remove all the cancer, providing a “high cure rate” without removing too much skin.
“Because we’re able to check 100% of the margin with the Mohs micrographic technique, she doesn’t need radiation,” Soleymani says. “She doesn’t need any additional treatment.”
The most common nail cancers that dermatologists see are melanomas, which usually present as a black or dark brown streak down the nail. If people have squamous cell carcinomas of the nail, they look like a bleeding mass.
“Anytime you have a growth that doesn’t go away in about four weeks, that’s kind of our cue,” Soleymani says. “You should see your dermatologist.”
He recommends that everyone receive the HPV vaccine to prevent developing HPV-related cancers.
“The vaccine has been shown in a lot of emerging studies in the past couple of years to not only reduce the incidence of common things, like warts and obviously cervical cancer, which it came out for, but also reduce the risk and incidence of skin cancer related to HPV,” he says.
Life after cancer
While Garcia’s nail looks back to normal, she still feels traumatized.
“We consider a manicure something special,” she says. “And this happens.”
Garcia has to follow up with her dermatologist for regular skin cancer screenings. She feels it’s important to speak up about her experience to raise awareness and encourage people who do get manicures and pedicures to make sure they watch the nail technicians use new tools. She also urges people to be persistent if something feels wrong with their health.
“I fought all the way from day one because I knew something was wrong,” Garcia says.