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Treatment of Subungual Melanoma

Summary and Comment |
January 22, 2014

Treatment of Subungual Melanoma

  1. Murad Alam, MD, MSCI

Conservative removal of tumors did not result in worse prognosis than more radical resection.

  1. Murad Alam, MD, MSCI

Subungual malignant melanoma is a rare manifestation of cutaneous melanoma (occurring in 0.7% to 3% of cases). Diagnosis is often delayed, and survival rates at 5 years are not promising. These authors report a case series and a review of 124 cases of subungual melanoma treated at the Mayo Clinic from 1914 to 2010 with primary resection and confirmed negative margins.

Mean duration of symptoms before diagnostic biopsy was 2.2 years. At diagnosis, most patients were found to have local disease involvement only (83.9%). Mean Breslow depth in 76 lesions diagnosed after 1970 was 3.1 mm. In all, 116 patients underwent amputations, and the amputations were classified for level of resection. Progression-free, overall, and disease specific survival were not significantly affected by amputation level once histologically free margins were obtained.

Comment

These results suggest that conservative removal of tumors did not result in worse prognosis than more radical resection. When thumbs required amputation, appropriate modifications were particularly useful for preserving as much function as possible. Subungual melanoma is a feared complication, but fortunately it is relatively uncommon. When it does occur, it is often detected late and in an advanced stage. Although this case series is from a single center and includes patients collected over almost a century, during which time standard treatments have evolved, the results do suggest that proximal amputations and consequent severe functional loss can be avoided in most cases without worsening prognosis.

  • Disclosures for Murad Alam, MD, MSCI at time of publication Grant / research support Medicis; OptMed; Valeant Editorial boards Archives of Dermatology; Dermatologic Surgery; Journal of Cosmetic Dermatology; Lasers in Medical Science; Skin Therapy Letter Leadership positions in professional societies American Academy Of Dermatology (Chair, Health Care Finance Committee); American College of Mohs Surgery (Board of Directors); American Society for Dermatologic Surgery (Board of Directors); American Society for Lasers in Medicine and Surgery (Chair, Scientific Program)

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Reader Comments (1)

AlejandroMoralesMD Physician, Dermatology, Office

Good advice for un uncommon condition

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