Mohs micrographic surgery for the treatment of in situ nail apparatus melanoma: A case report

Banfield, Cedric C.; Dawber, R.P.R.; Walker, N. P. J.; Stables, G.I.; Zeina, B.; Schomberg, Kate

doi:10.1016/s0190-9622(99)70535-9

Cited by 49 publications

(30 citation statements)

References 11 publications

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“…In one case of in situ nail melanoma, HMB-45 was proven to be the best method for detecting nail apparatus melanocytes. 23 Similarly, in 9 other cases of in situ ALM including 4 nail apparatus melanoma, all the lesions demonstrated strong positive staining with HMB-45, whereas S-100 protein was weakly positive or even negative in atypical melanocytes. 17 Recently Imakado et al reported 2 cases of subungual in situ melanoma.…”

Section: Discussionmentioning

confidence: 85%

Immunohistochemical Study of 40 Cases of Longitudinal Melanonychia

Theunis¹,

Richert²,

Saß³

et al. 2011

The American Journal of Dermatopathology

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The etiology of longitudinal melanonychia (LM) is difficult to establish by clinical and dermoscopic examinations alone. Microscopic examination of the nail matrix remains crucial. Two groups of LM may be identified: melanocytic activation (melanic pigmentation of the matrix epithelium without any increase in the density of melanocytes) and melanocytic proliferation (lentigo, nevus, or melanoma). The histological examination is challenging, and immunohistochemical investigations can be helpful. The objective of this study was to analyze the immunohistochemical findings with routinely used markers in melanocytic tumors-S-100 protein, HMB-45, and Melan-A-in LM. A series of 40 cases were analyzed: 10 activations, 4 lentigines, 7 nevi, 12 in situ melanomas, and 7 invasive melanomas. The sensitivity of S-100 protein is weak in benign and malignant intraepithelial melanocytes of the nail matrix, and if this marker is performed alone, it may be wrongly reassuring. However, the use of S-100 protein is essential to differentiate invasive melanoma, lacking an intraepithelial component, and particularly desmoplastic melanoma, from epithelial and mesenchymal tumors. HMB-45 and Melan-A are more sensitive than S-100 protein for the evaluation of intraepithelial melanocytic proliferation of the nail apparatus, with HMB-45 being the most intense marker. In the dermal component, HMB-45 and Melan-A were less sensitive than S-100 protein. In conclusion, we recommend that the panel of antibodies used for histological evaluation of LM should include HMB-45 and/or Melan-A and S-100 protein only if an invasive melanoma is suspected.

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Section: Discussionmentioning

confidence: 85%

Immunohistochemical Study of 40 Cases of Longitudinal Melanonychia

Theunis¹,

Richert²,

Saß³

et al. 2011

The American Journal of Dermatopathology

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“…Most studies reporting this technique have been only case studies or small series in which only patients with subungual melanoma in situ were included. [27][28][29][30] In these series, no deaths and only 1 recurrence 28 have been reported, but obtaining adequate margins often required DIP amputation. Brodland reported a series of 14 patients with subungual melanoma of various stages treated with Mohs micrographic surgery in which 86% of patients were alive or died of other causes without evidence of disease at a mean follow-up of 7.7 years.…”

Section: Directions For Future Researchmentioning

confidence: 84%

Subungual Malignant Melanoma

Martín

English

Goitz

2011

The Journal of Hand Surgery

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“…Mohs micrographic surgery is a good diagnostic tool, 9 but routine hematoxylin and eosin examination and immunohistopathologic staining of the formalin-fixed tissue are necessary for an accurate diagnosis. Although minimum resection without amputation is recommended for in situ and minimally invasive nail apparatus melanoma, accurate prediction of the depth of invasion is occasionally difficult, even by partial biopsy.…”

Section: Discussionmentioning

confidence: 99%