Mohs micrographic surgery for nail unit tumours: an update and a critical review of the literature

Abstract

Mohs micrographic surgery (MMS) is a good treatment option for epithelial neoplasms, especially when localized in areas where tissue conservation is crucial, such as the nail unit (NU). MMS is a method of radical excision offering high cure rates due to the margin control and functional preservation. Our aim is to provide a review on the use of MMS for the treatment of the most common nail tumours. We revised the current literature on the use of MMS to treat malignant neoplasms (Bowen's disease, squamous cell carcinoma, melanoma, basal cell carcinoma, keratoacanthoma, carcinoma cuniculatum) and benign neoplasms (onychomatricoma and glomus tumour). MMS represents a successful surgical option for nail tumours, firstly in terms of tissue conservation: the NU anatomy is complex and the preservation of the component structures is imperative for its functionality. Secondly, due to the surgical radicality, which is essential not only for the clearing of malignant tumours, but also for benign cases, in order to reduce recurrences. Although a conservative treatment of NU melanoma with MMS has been proposed, in our experience, the conservative approach with functional surgery is a good option for the treatment of non-invasive melanoma (in situ and Ia).

It's time forMohs: Micrographic surgery for the treatment of high‐risk basal cell carcinomas of the head and neck regions

“…2,4 Mohs micrographic surgery (MMS) is a technique that allows intraoperative microscopic control of the surgical margins and is a good treatment option when tissue conservation is required for esthetic or functional reasons (ie, face, genitalia, periocular tissues, or nail unit) or for high-risk lesions. [5][6][7][8][9][10][11][12][13][14] The present study aimed to evaluate the recurrence rate of head and neck high-risk BCCs comparing MMS vs conventional surgical excision in a single institution experience.…”

Oral and nail pigmentations: a useful parallelism for the clinician

“…A biopsy is recommended for single/isolated pigmented lesions, even if the diagnosis of an inflammatory disease is already confirmed by the history. Indeed, in both locations melanoma should be ruled out, as well as some neoplasms such as pigmented Bowen disease, squamous cell carcinoma and pigmented onychopapilloma .…”

Onychoscopy

“…• Prognosis and treatment: Excision is the treatment of choice for both Bowen's disease and invasive SCC. Moh's surgery is well-established and increasingly used (Lambertini et al 2018). Whether local excision, Moh's surgery, or amputation is the best treatment for a particular patient depends on the benefits of tissue sparing, bone involvement, and risk of recurrence or metastasis.…”

“…These tumors have an indolent growth pattern and a very low rate of metastasis (Richert et al 2013). However, local progression (up to 60% of cases of bone involvement in the distal phalanx) and recurrences are the main concern for clinicians (Lambertini et al 2018). • Differential diagnosis: Viral warts, onychomycosis, posttraumatic nail dystrophy, subungual exostosis, chronic paronychia, periungual fibrokeratoma, onychopapilloma, onychomatricoma (Teysseire et al 2017), melanoma, and subungual keratoacanthoma (Richert et al 2013).…”