Reconstruction of a thumb defect with Integra following wide local excision of a subungual melanoma

Smock, Elliott; Barabas, Anthony; Geh, Jenny

doi:10.1016/j.bjps.2009.05.010

Cited by 33 publications

(30 citation statements)

References 5 publications

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“…Most cases of NAM treated with functional surgery report in situ or thin NAMs, with Breslow thickness <1 mm. Good prognosis of NAM and no recurrences after functional surgery of tumors presenting a Breslow thickness >1 mm have recently been reported in 3 patients by Nakamura et al [23], in another 3 by Rayatt et al [27] and in a single case by Smock et al [28]. The series of NAM we report here is the largest that includes patients with intermediate Breslow thickness (10 cases) with a conservative management and a long-term follow-up.…”

Section: Discussionmentioning

confidence: 99%

The Prognosis of Nail Apparatus Melanoma: 20 Years of Experience from a Single Institute

Dika

Patrizi²,

Fanti³

et al. 2016

Dermatology

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Introduction and Objectives: Nail apparatus melanoma (NAM) is an uncommon tumor, especially in Caucasians. The prognosis of patients affected by NAM was analyzed and correlated with the histopathological criteria and the surgical management of the tumors. Materials and Methods: We collected data regarding NAM referred to the Skin Cancer Unit of the Dermatology Department of the University of Bologna, from 1992 to January 2012. Results: Out of 1,327 melanoma cases diagnosed between 1992 and 2012, 42 patients were affected by NAM (2.93%). All the patients were Caucasian. Two deceased patients with insufficient medical records and 1 woman with a personal history of breast cancer were excluded. Thirty-nine cases entered this study: 24 were women (67%) and 15 men (33%). The mean age at diagnosis of NAM was 57.3 years (range 29-88 years). Statistical analyses showed that prognosis was significantly correlated with the Breslow thickness (≥/<2 mm; p = 0.02), regression (p < 0.0001) and ulceration (p = 0.04). Regarding surgical management, Kaplan-Meier's test pointed out that performing functional surgery compared to disarticulation did not correlate with a better prognosis of patients (p = 0.08). Conclusions: In our experience, the surgical management (disarticulation with respect to functional surgical excision) did not influence the prognosis of NAM patients. The latter was affected by the histopathological characteristics (Breslow thickness, regression and mitoses) and location (fingers vs. foot).

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Section: Discussionmentioning

confidence: 99%

The Prognosis of Nail Apparatus Melanoma: 20 Years of Experience from a Single Institute

Dika

Patrizi²,

Fanti³

et al. 2016

Dermatology

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“…However, recently SUM has often been managed by conservative surgery such as wide local excision (WLE) and grafting, with which good results were achieved [4][5][6] . Moreover, Moehrle et al [7] also proved that functional surgery is superior in terms of cure and survival and that the 2 independent poor prognostic factors are melanoma thickness and amputation.…”

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confidence: 99%

Is the Distance Enough to Eradicate in situ or Early Invasive Subungual Melanoma by Wide Local Excision? From the Point of View of Matrix-to-Bone Distance for Safe Inferior Surgical Margin in Koreans

Kim¹,

Jung²,

Lee³

et al. 2011

Dermatology

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“…Smock reported the case of a man with a 1.2 mm Breslow thickness subungual melanoma of his thumb who refused amputation 22. A 1 cm wide local excision down to bone was performed, and the defect was later grafted.…”

Section: Discussionmentioning

confidence: 99%

Missed opportunity to diagnose subungual melanoma: potential pitfalls!

Dunphy¹,

Morhij

Verma

et al. 2017

BMJ Case Reports

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Subungual melanoma, an uncommon form of acral melanoma that arises within the nail matrix, accounts for 1%-3% of all cutaneous melanoma in Caucasians. As subungual melanoma presents in a more disguised manner than cutaneous lesions, increased vigilance is required. It most commonly presents as a discolouration of the nail, nail splitting or nail-bed bleeding. Black pigmentation of the adjacent nail fold, termed Hutchinson's sign, may be a diagnostic clue. Treatment of subungual melanoma remains surgical with wide local excision and amputation primary modalities. We present the case of a 61-year-old man with an 18-month history of a left thumb nail-bed abnormality and a 6-week history of left axillary lymphadenopathy. One year earlier, he presented to the emergency department with a purulent discharge from his left thumb but declined nail-bed ablation. He was referred to the 'Hand and Plastic Injuries Clinic' by his general practitioner and diagnosed with a chronic traumatic-induced nail-bed injury. As his symptoms did not improve, he was referred to the 2-week wait Skin Cancer Clinic. The left thumb nail-bed was excised as a nail unit down to bone, and the diagnosis of melanoma was rendered. Left axillary lymphadenopathy was confirmed as metastatic melanoma. He underwent amputation of his left thumb at the interproximal phalangeal joint, and a left axillary node dissection was performed. No residual melanoma was identified in his thumb. Microscopically, his left axillary dissection confirmed 9 out of 36 positive nodes for metastatic melanoma with extracapsular spread. He was staged at IIIC disease. This case report demonstrates missed opportunities to diagnose subungual melanoma and acts as a cautionary tale in considering this pathology in the differential diagnosis of nail-bed lesions with prompt referral for further investigation.

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Reconstruction of a thumb defect with Integra following wide local excision of a subungual melanoma

Cited by 33 publications

References 5 publications

The Prognosis of Nail Apparatus Melanoma: 20 Years of Experience from a Single Institute

The Prognosis of Nail Apparatus Melanoma: 20 Years of Experience from a Single Institute

Is the Distance Enough to Eradicate in situ or Early Invasive Subungual Melanoma by Wide Local Excision? From the Point of View of Matrix-to-Bone Distance for Safe Inferior Surgical Margin in Koreans

Missed opportunity to diagnose subungual melanoma: potential pitfalls!

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