Subungual Melanoma

  • There is frequently a delay in diagnosis with subungual melanomas:
    • Due to the difficulty in performing an adequate biopsy and the pigmentation being masked by the nail
  • Biopsies:
    • Are usually not definitive for Breslow thickness:
      • Frequently these melanomas are thicker and more aggressive than initial appreciated
  • The standard of care is:
    • Distal amputation with SLNM and SLN biopsy:
      • Nguyen et al:
        • Reviewed a single-institution series of 124 cases of subungual melanomas:
          • In this series, mean thickness was 3.1 mm and the level of resection / amputation was not associated with survival outcomes
      • Cohen et al:
        • Reported that 5 (17%) of 30 patients who underwent SLN biopsy had nodal metastasis
      • Median thickness was 2.1 mm, with the most common site being the toe
    • In the Australian series, 79% were Clark level IV or V with a median thickness of 3.2 mm:
      • 24% of patients who underwent SLN biopsy had positive lymph nodes.
  • References:
    • Cohen T, Busam KJ, Patel A, Brady MS. Subungual melanoma: management considerations. Am J Surg. 2008;195:244-248.
    • Heaton KM, el-Naggar A, Ensign LG, Ross MI, Balch CM. Surgical management and prognostic factors in patients with subungual melanoma. Ann Surg. 1994;219:197-204.
    • Nguyen JT, Bakri K, Nguyen EC, Johnson CH, Moran SL. Surgical management of subungual melanoma: mayo clinic experience of 124 cases. Ann Plast Surg. 2013;71:346-354.

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