Functional Surgery for Malignant Subungual Tumors: A Case Series and Literature Review

Flores-Terry, M.Á.; Romero-Aguilera, G.; Mendoza, C.; Franco, M.; Cortina, P.; González‐Ruiz, Lucía; Garrido, José Aurelio Medina

doi:10.1016/j.adengl.2018.07.012

Cited by 14 publications

(47 citation statements)

References 34 publications

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“…In a study with 94 SUM patients, 44% had either positive sentinel lymph nodes or macroscopic lymph node metastases (Chakera et al, 2019). We This surgical treatment is associated with a very low rate of local recurrence (<7%) and offers better functional and cosmetic outcomes than amputation (Flores-Terry et al, 2018).…”

Section: Discussionmentioning

confidence: 88%

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Subungual melanoma: A single center series from Dresden

Wollina

Tempel

Hansel

2019

Dermatologic Therapy

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Subungual melanoma (SUM) is a rare subtype in Caucasians. Histologically, most tumors are of the acrolentiginous type (ALM). This is a retrospective analysis of the years 2002–2019 at a certified skin cancer center. We observed 12 SUM patients with a median age of 76 years, seven men and five women (0.6% of all melanomas). The delay of diagnosis reached from 30 years to several months. Hallux and thumb were the most affected localizations. The dominant histologic type was ALM. Clinical symptoms were nail plate destruction (90.9%), bleeding (50.0%), pigmentation of the nail plate (33.3%), and a positive Hutchinson sign (25.0%). All tumors were treated surgically with three‐dimensional margin control. In six patients, amputation was performed. Median relapse‐free survival and overall survival were (56 ± 73.5) months and (112.5 ± 135.1) months, respectively. SUM is rare among Caucasian patients. Nail plate pigmentation and Hutchinson sign were not frequent. Amelanotic ALM with nail plate destruction was the dominant presentation in our series. Dermoscopy is of limited value for amelanotic subungual tumors. Early biopsy of unusual or treatment resistant nail disorders is recommended.

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Section: Discussionmentioning

confidence: 88%

“…For thinner tumors (<1 mm) wide local excision or Mohs surgery can be recommended. This surgical treatment is associated with a very low rate of local recurrence (<7%) and offers better functional and cosmetic outcomes than amputation (Flores‐Terry et al, ).…”

Section: Discussionmentioning

confidence: 99%

Subungual melanoma: A single center series from Dresden

Wollina

Tempel

Hansel

2019

Dermatologic Therapy

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“…Details about gender distribution were available in 28 studies and showed a male/female ratio between 0.3–2.5 : 1 . Information on population age was given in 28 studies with a reported average age between 41.1 and 67 years (age range: 5–94 years) . A total of 818 of the NAM were located on the hand and 522 lesions on the foot.…”

Section: Resultsmentioning

confidence: 99%

“…Tumour thickness was reported in 29 studies. Mean Breslow values were available from 12 studies with unselected tumour thicknesses and ranged from 0.82 to 8.70 mm . Ulceration status was mentioned with rates between 8.3% and 70.8% in 13 studies .…”

Section: Resultsmentioning

confidence: 99%

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Melanoma of the nail apparatus: a systematic review and meta‐analysis of current challenges and prognosis

Lieberherr

Cazzaniga

Haneke

et al. 2020

Acad Dermatol Venereol

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Nail apparatus melanoma (NAM) is a rare dermatologic malignancy. Its prognosis is poor because it is often diagnosed late. However, progression and survival of NAM patients have only been studied among small populations. Early biopsy could help to identify suspicious lesions at a less invasive stage. While surgery is generally seen as the treatment of choice, the extent of excision margins and the use of sentinel biopsy remain debated. This systematic review aims to summarize the treatment procedures and observed prognosis in the literature during the last two decades and present pooled survival and progression rates of NAM by using meta-analysis. A systematic review on studies assessing pathology, treatment and prognosis of NAM was carried out up to end of 2018. After evaluation of eligible studies, the main emerging topics were outlined and pooled survival outcomes estimated. A total of 30 articles out of 624 identified records were included for systematic review. Finally, meta-analysis of pooled mortality rates including 18 studies was 4.6 9 100 patient-years (95% CI: 2.7, 6.8) equivalent to 5-year cumulative survival of 77.0%. Additionally, the pooled progression rate based on 17 studies was 6.3 9 100 patient-years (95% CI: 4.1, 8.9) with estimated 5-year cumulative progression-free survival of 68.5%. While the optimal extent of surgical treatment remains debated, prompt biopsy could help to identify early lesions. This is the first study to present pooled survival and progression rates by meta-analysis.

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