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Subungual melanoma

J E Krige1, D A Hudson, C A Johnson

  • 1Department of General and Plastic Surgery, University of Cape Town.

South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie
|March 1, 1995
PubMed
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Melanoma of the nail bed is rare but aggressive. Delayed diagnosis and misdiagnosis contribute to poor outcomes, with a 5-year survival rate of only 26% for this cancer.

Area of Science:

  • Dermatology
  • Oncology
  • Pathology

Background:

  • Malignant melanoma can arise in the nail bed, a rare but potentially aggressive form of skin cancer.
  • Early diagnosis is crucial for effective treatment and improved patient outcomes.

Purpose of the Study:

  • To analyze the clinical characteristics, treatment, and survival rates of patients with malignant melanoma of the nail bed.
  • To identify factors contributing to the poor prognosis associated with this condition.

Main Methods:

  • Retrospective review of 1,350 malignant melanoma cases over 17 years.
  • Analysis of patient demographics, lesion characteristics, diagnostic delays, treatment modalities, and survival data.

Main Results:

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  • Twenty cases (1.5%) of nail bed melanoma were identified, with the thumb and big toe most commonly affected.
  • A significant delay in diagnosis (mean 1.4 years) and high rates of misdiagnosis (40%) were observed.
  • Mean Breslow depth was 5.7 mm, with acral lentiginous melanoma being the predominant subtype.
  • The 5-year survival rate was 26%, with delayed diagnosis and advanced disease contributing to poor prognosis.

    • Conclusions:

    • Nail bed melanoma is associated with delayed diagnosis, frequent misdiagnosis, and advanced disease at presentation.
    • Aggressive treatment, including digit amputation and node dissection, is often required.
    • Improved awareness and diagnostic accuracy are essential to improve survival rates for nail bed melanoma.