Management and treatment of nail melanoma

An early and prompt nail apparatus melanoma (NAM) diagnosis is associated with less invasive surgical procedures and a better patient's prognosis. The diagnostic delay may be related both to the clinical misinterpretations and to errors in the diagnosing process. Biopsy techniques have been adequately described by nail experts, but the two main problems in the correct choice of the biopsy are probably related to the difficulty in performing surgery in the nail unit and the risk of permanent nail dystrophy.

We retrospectively investigated anamnestic data and diagnostic procedures that all NAM patients referred from 1992 to January 2014, with the following objectives: 1) to evaluate the initial misdiagnoses and quantify the diagnostic delay; 2) to correlate the type of the initial biopsy with the achievement of the correct diagnosis.

In our cases it was easier for a non-dermatologist to misdiagnose NAM for a benign inflammatory disease. Dermatologist instead were easier to refer patients to a tertiary center for nail diseases.

In the presence of a NAM clinical and dermoscopic suspicion, longitudinal biopsy is recommended in all cases of nail pigmentation (lateral or median), that is estimated in its width as 3-6 mm, or larger than 6 mm. Regarding therapeutic surgery in our experience disarticulation compared to "functional surgical excision" did not correlate with a better prognosis.