In situ subungual melanoma: digit salvaging clearance

Acral lentiginous melanoma affecting the nail is uncommon but carries a poor prognosis due to difficulties in early diagnosis. The gold standard of treatment for subungual melanoma is biopsy followed by wide local excision in form of amputation of the distal phalanx of the digit, in order to achieve at least 10 mm margin of clearance or by fixed tissue micrographic (Mohs') surgery. Here, we demonstrate a non-amputative approach for the excision of subungual melanoma in situ of the right great toe, involving removal of the nail unit with a layer of underlying bone before reconstruction with full thickness skin graft. This technique allows adequate excision margins to ensure full clearance of the lesion with satisfactory preservation of function.