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A Call for Evidence-Based Conservative Management of Nail Unit Malignancies
Katherine M Stiff1, Nathaniel Jellinek1, Thomas J Knackstedt1
1From the Department of Dermatology, MetroHealth System; Dermatology Professionals, Inc.; Department of Dermatology, Warren Alpert Medical School at Brown University; Department of Dermatology, University of Massachusetts Medical School; and School of Medicine, Case Western Reserve University.
Summary:
Nail unit squamous cell carcinoma and melanoma are the most common malignancies of the nail apparatus. Compared to their cutaneous counterparts, they are diagnosed later and perceived as more aggressive. This may result in overzealous management, including radiographic imaging with poor sensitivity and specificity, interventional nodal staging by sentinel lymph node biopsy, amputation over digit-sparing tumor resections, and elaborate reconstructions after tumor extirpation. In this review article, the authors evaluate the evidence behind several misconceptions in nail malignancy management and provide evidence-based guidance for more conservative care.
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