Ungual melanoma - controversies in diagnosis and treatment

Abstract

Ungual melanomas are considered rare, being difficult to diagnose, and having a poor prognosis. The aim of the present study was to discuss the epidemiology, potential causes, treatment options, and outcome of ungual melanomas. In contrast to assumptions in many articles, ungual melanomas are not rare when calculated for the cumulative size of the nail apparatus of both the fingers and toes. The prognosis is not worse than that of melanomas with the same thickness, mitotic rate, or presence of ulceration on other sites. Melanomas of the nail apparatus behave similar to melanomas in other localizations. What makes them enigmatic is the high rate of misdiagnoses and very late diagnoses.

Nail Apparatus Melanoma: Experience of 10 Years in a Single Institution

“…NAM is more frequent between the ages of 50 and 70 years [1], but in rare occasions can also be observed in children [24,25]. More than half of the subjects were younger than 50 years, including an 8-year-old child.…”

“…The literature is unclear about which gender is more affected [1]. In Japan, Korea, and Taiwan, there is a male predominance [16][17][18], whereas a female predominance is observed in Western countries [6,19,20].…”

“…There was only 1 Asian patient in this study (5.3%). In absolute numbers, NAM incidence in Caucasians and African-Americans is very similar [11,26], although NAM represents 20% of all melanoma cases in African-Americans and 1.5-2% of all melanoma cases in Caucasians [1,21,26,27].…”

“…Nail apparatus melanoma (NAM) can be either subungual or periungual, depending on whether it is located under the nail or around the nail, and most arise from abnormal nail matrix melanocytes [1,2]. It was first described by Boyer [3] in 1834 and then by Hutchinson [4] in 1886.…”

Current Surgical Management of Acral Lentiginous Melanoma

“…Comparative studies of various amputation levels have not shown any advantages for metacarpal amputations over metacarpophalangeal (MP), proximal interphalangeal (PIP), or distal interphalangeal (DIP) amputations [30]; this means that the prognosis of SUM does not depend on the amputation level but on the clinical stage [31]. Therefore, the recent trend of surgery is to utilize more distal amputations, without compromising recurrence or survival [25,26].…”