Ann Dermatol.  2015 Aug;27(4):417-422. 10.5021/ad.2015.27.4.417.

Delayed Reconstruction for the Non-Amputative Treatment of Subungual Melanoma

• Oh BH
• Jang HS
• Lee J
• Choi MJ
• Nam KA
• Chung KY

• KMID: 2171499
• DOI: http://doi.org/10.5021/ad.2015.27.4.417

Abstract

BACKGROUND
In cases of early stage subungual melanoma (SUM), conservative treatment with non-amputative wide excision of the nail unit and subsequent skin graft is preferred over amputation to preserve the involved digit.
OBJECTIVE
We report a series of patients with SUM treated with conservative surgery and suggest an effective supplementary treatment process.
METHODS
We retrospectively reviewed 10 patients (2 males, 8 females) who were diagnosed with in situ or minimally invasive SUM on the first biopsy and underwent non-amputative wide excision of the nail unit. All patients underwent secondary intention healing during the histopathological re-evaluation of the entire excised lesion, and additional treatment was administered according to the final report.
RESULTS
In two of 10 patients, amputation was performed because of the detection of deep invasion (Breslow thickness: 4.0, 2.3 mm) from the final pathologic results, which differed from the initial biopsy. In six patients who received delayed skin graft, the mean total time required for complete healing after secondary intention healing and the skin graft was 66.83+/-15.09 days. As a result of this delayed skin graft, the final scarring was similar to the original shape of the nail unit, scored between 5 and 10 on a visual analogue scale. Most patients were satisfied with this conservative surgery except one patient, who had volar portion involvement and received an interpolated flap instead of a skin graft.
CONCLUSION
Our treatment process can reduce the risk of incomplete resection and improve cosmetic outcomes in patients with SUM.

Keyword

Amputation; Skin graft; Non-amputative wide excision; Secondary intention healing; Subungual melanoma

MeSH Terms

Amputation
Biopsy
Cicatrix
Humans
Intention
Male
Melanoma*
Retrospective Studies
Skin
Transplants

Figure

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  Fig. 1 Diagram of treatment process.

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  Fig. 2 Images of clinical progress. (A) Case no. 9. An 18-year-old female patient was diagnosed with melanoma in situ from the initial skin biopsy. (B) Excision with a 0.5-cm-wide margin was performed, and tumor clearance was subsequently confirmed by histopathological re-evaluation in the entire excised lesion. (C) The deep margin was bone contact. (D) Granulation tissues were sufficiently formed during a secondary healing period of 34 days after wide excision. (E) Skin graft was subsequently performed. (F) Complete healing was observed 16 days after skin graft.

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  Fig. 3 Clinical images of case case no. 4 (female/76). (A) Wide excision was performed with a 0.5-cm safety margin from the pigmented lesion and nail structure. (B) Two months later, an interpolated flap was made using the skin of the adjacent fingers to restore the skin defect.

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