Abstract
Aim: Subungual melanoma is a rare entity. The literature lacks information about its treatment. Alternative treatments exist; amputation or wide local excision (WLE), with or without sentinel lymph
node biopsy (SLNB). This study discusses the classical approach for subungual melanoma and compares it with the alternatives.
Materials and Methods: A retrospective analysis of subungual melanoma cases between 2008 and 2020 in a tertiary center was done.
Results: Thirteen patients were found to have subungual melanoma. Amputation and SLNB were the treatment of choice in 12 patients with invasive diseases. In one patient with a in-situ illness, WLE and SLNB were applied. Mean Breslow thickness was found to be 4.2 mm. The preoperative evaluation showed no signs of metastases in 10 patients, and these patients had SLNB. Two patients had
pathological lymph node characteristics in the preoperative evaluation and had elective lymph node dissection (ELND) without SLNB. The mean follow-up was six years, and seven patients died during the follow-ups. Six patients died of natural causes, while one died of systemic disease.
Conclusion: Subungual melanoma is a disease that can be controlled with amputation. WLE can be used in in-situ melanomas, but amputation is still a good choice for invasive illnesses.
References
- Dawber RP, Colver GB. The spectrum of malignant melanoma of the nail apparatus. Seminars in dermatology 1991;10(1):82-7.
- Cochran AM, Buchanan PJ, Bueno Jr RA, Neumeister MW. Subungual melanoma: a review of current treatment. Plastic and reconstructive surgery, 2014;134(2):259-73.
- Reilly DJ, Aksakal G, Gilmour RF, Gyorki DE, Chauhan A, Webb A, Henderson MA. Subungual melanoma: Management in the modern era. Journal of Plastic, Reconstructive & Aesthetic Surgery 2017;70(12):1746-52.
- Anda-Juárez MCD, Martínez-Velasco MA, Fonte-Ávalos V, Toussaint-Caire S, Domínguez-Cherit J. Conservative surgical management of in situ subungual melanoma: long-term follow-up. Anais brasileiros de dermatologia 2016;91(6):846-8.
- Möhrle M, Häfner HM. Is subungual melanoma related to trauma? Dermatology 2002;204(4):259-61.
- Cohen T, Busam KJ, Patel A, Brady MS. Subungual melanoma: management considerations. The American journal of surgery 2008;195(2):244-8.
- Deinlein T, Hofmann-Wellenhof R, Zalaudek I. Acral melanoma mimicking subungual hematoma. J Am Acad Dermatol. 2016;75(5):e181-e183. doi:10.1016/j.jaad.2016.02.12228.
- O'Connor EA, Dzwierzynski W. Longitudinal melonychia: clinical evaluation and biopsy technique. J Hand Surg Am. 2011;36(11):1852-1854. doi:10.1016/j.jhsa.2011.08.029.
- Rayatt SS, Dancey AL, Davison PM. Thumb subungual melanoma: is amputation necessary?. J Plast Reconstr Aesthet Surg. 2007;60(6):635-638. doi:10.1016/j.bjps.2006.10.014.
- Quinn MJ, Thompson JE, Crotty K, McCarthy WH, Coates AS. Subungual melanoma of the hand. J Hand Surg Am. 1996;21(3):506-511. doi:10.1016/S0363-5023(96)80371-6.
- Oh BH, Jang HS, Lee J, Choi MJ, Nam KA, Chung KY. Delayed Reconstruction for the Non-Amputative Treatment of Subungual Melanoma. Ann Dermatol. 2015;27(4):417-422. doi:10.5021/ad.2015.27.4.417.
- Lee KT, Park BY, Kim EJ, et al. Superthin SCIP Flap for Reconstruction of Subungual Melanoma: Aesthetic Functional Surgery. Plast Reconstr Surg. 2017;140(6):1278-1289. doi:10.1097/PRS.0000000000003881.
Bir üçüncü basamak merkezde subungual melanomların kapsamlı analizi: Amputasyon eski bir seçenek mi?
Abstract
Amaç: Subungual melanom nadir görülen bir durumdur. Literatürde tedavisi hakkında detaylı bilgi bulunmamaktadır. Alternatif tedaviler mevcuttur; sentinel lenf nodu diseksiyonu ile birlikte veya
yalnızca amputasyon veya geniş lokal eksizyon (WLE) uygulanabilmektedir. Bu çalışmada subungual melanom için klasik yaklaşım tartışılmış ve alternatifleri ile karşılaştırılmıştır.
Gereç ve Yöntem: Üçüncü basamak bir merkezde 2008 ve 2020 yılları arasındaki subungual melanom vakalarının retrospektif analizi yapılmıştır.
Bulgular: 13 hastada subungual melanom tespit edilmiştir. İnvaziv hastalığı olan 12 hastada tedavi ampütasyon ve SLNB’dir. Yalnızca in-situ melanomu olan bir hastaya, WLE ve SLNB uygulanmıştır.
Ortalama Breslow kalınlığı 4,2 mm’dir. Ameliyat öncesi değerlendirmede hastaların 10'unda metastaz bulgusu görülmemiş ve bu hastalara SLNB uygulanmıştır. İki hastada preoperatif değerlendirmede patolojik lenf nodu özellikleri saptanmış ve SLNB'siz elektif lenf nodu diseksiyonu (ELND) tedaviye
eklenmiştir. Ortalama takip süresi 6 yıldır ve takipler sırasında 7 hasta kaybedilmiştir. Hastaların altısı doğal nedenlerle, bir hasta ise sistemik hastalıklardan kaybedilmiştir.
Sonuç: Subungual melanom amputasyon ile kontrol altına alınabilen bir hastalıktır. WLE, in-situ melanomlarda kullanılabilir; ancak amputasyon invaziv hastalıklar için hala iyi bir seçimdir.
References
- Dawber RP, Colver GB. The spectrum of malignant melanoma of the nail apparatus. Seminars in dermatology 1991;10(1):82-7.
- Cochran AM, Buchanan PJ, Bueno Jr RA, Neumeister MW. Subungual melanoma: a review of current treatment. Plastic and reconstructive surgery, 2014;134(2):259-73.
- Reilly DJ, Aksakal G, Gilmour RF, Gyorki DE, Chauhan A, Webb A, Henderson MA. Subungual melanoma: Management in the modern era. Journal of Plastic, Reconstructive & Aesthetic Surgery 2017;70(12):1746-52.
- Anda-Juárez MCD, Martínez-Velasco MA, Fonte-Ávalos V, Toussaint-Caire S, Domínguez-Cherit J. Conservative surgical management of in situ subungual melanoma: long-term follow-up. Anais brasileiros de dermatologia 2016;91(6):846-8.
- Möhrle M, Häfner HM. Is subungual melanoma related to trauma? Dermatology 2002;204(4):259-61.
- Cohen T, Busam KJ, Patel A, Brady MS. Subungual melanoma: management considerations. The American journal of surgery 2008;195(2):244-8.
- Deinlein T, Hofmann-Wellenhof R, Zalaudek I. Acral melanoma mimicking subungual hematoma. J Am Acad Dermatol. 2016;75(5):e181-e183. doi:10.1016/j.jaad.2016.02.12228.
- O'Connor EA, Dzwierzynski W. Longitudinal melonychia: clinical evaluation and biopsy technique. J Hand Surg Am. 2011;36(11):1852-1854. doi:10.1016/j.jhsa.2011.08.029.
- Rayatt SS, Dancey AL, Davison PM. Thumb subungual melanoma: is amputation necessary?. J Plast Reconstr Aesthet Surg. 2007;60(6):635-638. doi:10.1016/j.bjps.2006.10.014.
- Quinn MJ, Thompson JE, Crotty K, McCarthy WH, Coates AS. Subungual melanoma of the hand. J Hand Surg Am. 1996;21(3):506-511. doi:10.1016/S0363-5023(96)80371-6.
- Oh BH, Jang HS, Lee J, Choi MJ, Nam KA, Chung KY. Delayed Reconstruction for the Non-Amputative Treatment of Subungual Melanoma. Ann Dermatol. 2015;27(4):417-422. doi:10.5021/ad.2015.27.4.417.
- Lee KT, Park BY, Kim EJ, et al. Superthin SCIP Flap for Reconstruction of Subungual Melanoma: Aesthetic Functional Surgery. Plast Reconstr Surg. 2017;140(6):1278-1289. doi:10.1097/PRS.0000000000003881.
Details
| Primary Language | English |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Research Articles |
| Authors | |
| Publication Date | March 15, 2023 |
| Submission Date | May 23, 2022 |
| Published in Issue | Year 2023Volume: 62 Issue: 1 |
