Clinicopathologic Characteristics of Trauma-Related Nail Apparatus Melanoma: A Comparative Study according to the Presence of Trauma prior to Melanoma Development

Abstract

<b><i>Background:</i></b> Nail apparatus melanoma (NAM) is a subtype of cutaneous melanoma occurring at nail units and belongs to the acral lentiginous melanoma subgroup. Due to its unique anatomical structure to protect the acral site, mechanical trauma may have a clinicoprognostic impact on NAM. Therefore, we investigated the clinicoprognostic and histopathological characteristics of NAM according to the presence of trauma history prior to melanoma development. <b><i>Methods:</i></b> Clinicopathological and follow-up data of patients with NAM according to trauma history were obtained. <b><i>Results:</i></b> We included 87 patients with NAM, 21.8% of whom had a previous trauma history. Trauma-related NAMs were more likely to involve the toenail (<i>p</i> = 0.040), include a high proportion of amelanotic melanomas (<i>p</i> = 0.038) as well as nail bed tumor (<i>p</i> = 0.013), and have a longer time interval between the onset of nail change and confirmed diagnosis (<i>p</i> = 0.012). Moreover, survival analysis revealed that trauma-related NAMs more frequently showed progression in general (<i>p</i> = 0.034) and nodal metastasis (<i>p</i> = 0.047) and had worse prognosis in terms of progression-free survival (<i>p</i> = 0.004). <b><i>Conclusion:</i></b> In conclusion, NAMs with previous trauma have unique clinicoprognostic characteristics. The specific clinicopathological features of NAMs according to trauma indicate that trauma may play a role in melanoma development.

Early-stage acral melanoma with a history of trauma associated with a poor prognosis:A multicenter data analysis of 468 cases

“…While the proportion of patients with Breslow thickness > 2-4mm and > 4mm was higher than that of the non-trauma group. In a study in South Korea, which is also an East Asian country, the same nding of a trauma group was found to have a bias toward advanced pathologic staging [7]. These ndings suggest an association between trauma and later tumor stage as well as adverse pathological features.…”

“…Previous studies have suggested that trauma may be a risk factor for the prognosis of AM,the risk of patients who had suffered trauma to die of melanoma was about ve times greater than that of patients without trauma [7,13,14]. This prompted us to explore in depth the in uence of trauma on AM tumor progression, recurrence, and survival outcomes.…”

“…Because the sites of predilection for AM are mainly unexposed to the sun, considered less relevant to ultraviolet exposure. Previous studies have suggested that penetrating wounds, weight-bearing, and exposure to agricultural chemicals are risk factors that in uence the development and survival prognosis of AM, but these ndings remain controversial [4][5][6][7][8][9][10][11].…”

Nail Apparatus Melanoma: Current Management and Future Perspectives

“…Common risk factors for cutaneous melanoma, such as fair skin, sun exposure, and a family history of melanoma, do not apply to NAM [ 11 , 12 ]. Instead, trauma, chronic inflammation, and mechanical stress, which are thought to contribute to acral melanoma development [ 13 , 14 , 15 , 16 ], may also play some roles in NAM development [ 17 ]. A recent report comparing NAM with non-NAM acral melanoma (54 NAMs and 78 non-NAM acral melanomas) reported that patients with NAM were younger at diagnosis, had a higher prevalence of primary melanoma on the hand, and had more frequent reports of previous trauma at the tumor site [ 18 ].…”

Adult and Pediatric Nail Unit Melanoma: Epidemiology, Diagnosis, and Treatment

“…In a retrospective study of 406 patients with NUM, 58% of all cases of the fingers were localized to the thumb, while 86% of all cases on the toes were localized to the hallux [ 8 ]. In a comparative study of 87 patients with NUM, 21.8% recalled previous trauma history, and trauma-related cases were more likely to involve the toenail ( p = 0.4) [ 9 ]. The role of trauma remains unclear because it is subject to recall bias and patients with trauma may visit physicians more frequently and thus be diagnosed [ 7 ].…”