Wide local en bloc excision of subungual melanoma in situ

Subungual melanoma is a rare but lethal form of melanoma. Amputation at the level of the interphalangeal joint or proximal has been described as appropriate surgical management for all stages of subungal melanoma. In cases of subungual melanoma in situ (SMIS), wide local excision can improve functional and aesthetic outcomes. We reviewed our experience of wide local excision for the treatment of SMIS. Between 2003 and 2010, we treated 9 cases of SMIS. We performed a retrospective review of this series looking at the primary outcomes of recurrence or metastasis. Average age was 40 years (range, 5-65 years). Presenting lesions were on the thumb (5) and index finger (4). All patients underwent definitive reconstruction with a combination of full-thickness skin graft (8) and paronychial advancement flap (6). Reexcision was performed when disease-free margins could not be confirmed. To date, there have been no cases of metastasis or local recurrence in any of our 9 patients (mean follow-up time of more than 4 years). Wide local excision can improve functional and aesthetic outcomes with similar success in rates of local recurrence and metastasis when compared to treatment by amputation in SMIS.