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Nail-bed melanoma.

J M Klausner, M Inbar, M Gutman

    Journal of Surgical Oncology
    |March 1, 1987
    PubMed
    Summary
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    Subungual melanoma, rare skin cancer on the nail bed, often presents late, leading to delayed diagnosis and advanced disease. Early detection and surgical intervention are crucial for improving patient outcomes in these challenging cases.

    Area of Science:

    • Oncology
    • Dermatology
    • Surgical Pathology

    Background:

    • Subungual melanoma is a rare variant of cutaneous melanoma.
    • Primary lesions in the nail bed represent a small percentage of overall melanoma cases.

    Purpose of the Study:

    • To analyze the clinical characteristics, diagnostic delays, and treatment outcomes of subungual melanoma.
    • To highlight the challenges in early diagnosis and management of nail bed melanomas.

    Main Methods:

    • Retrospective case series analysis of 348 patients over a 10-year period.
    • Review of patient records focusing on lesion location, type, diagnostic delay, treatment, and survival.
    • Surgical interventions included amputation and lymph node dissection.

    Main Results:

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    • Six cases (1.7%) of subungual melanoma were identified, predominantly on toes.
    • Significant diagnostic delays (7 months to 6 years) were observed, with four patients presenting with advanced disease.
    • Surgical treatment, including amputation and lymph node dissection, was the primary approach.
    • Prognosis was poor for patients with advanced or metastatic disease, with high mortality rates.
    • Patients with early-stage disease confined to the nail bed showed better survival post-treatment.

    Conclusions:

    • Subungual melanoma is frequently diagnosed at advanced stages due to subtle presentation and delayed patient/physician recognition.
    • Acral lentiginous melanoma is a common subtype in this location.
    • Aggressive surgical management is necessary, but outcomes are significantly influenced by the stage at diagnosis.
    • Further research into earlier diagnostic markers and treatment strategies for subungual melanoma is warranted.