Subungual melanoma: an eighteen-year review

Subungual melanoma is a rare lesion comprising 1% to 3% of all melanoma cases.

Records of twenty-two patients with subungual melanoma treated at Roswell Park Cancer Institute during the period September 1971 to September 1989 were reviewed in a retrospective manner. Most common sites of involvement were the great toe on the foot (n = 7), the thumb (n = 4), and the index (n = 3) and ring fingers (n = 3) on the hand. Common signs included pigmentation of the nail bed, nail loss, and nail destruction.

Thickness of the lesion could be determined in 10 patients. All four patients with lesions 1.0 mm and thinner at the time of biopsy were alive and disease free at 19, 20, 55, and 78 months, whereas three of six patients with lesions thicker than 1.0 mm were dead at 15, 51, and 56 months. Patients with ulcerated lesions had an estimated 5-year survival rate of 39% as compared with 80% for the group without ulceration. Seven patients underwent finger amputations distal to the metacarpophalangeal joint, and none experienced local recurrence. Four amputations were just proximal to the distal interphalangeal joint, and three were just proximal to the proximal interphalangeal joint. One of these patients died of metastatic melanoma at 56 months, and the other six were alive and disease free at 13, 19, 20, 32, 72, and 78 months from the time of diagnosis.

More distal amputations of subungual melanomas of the hand preserve function and do not compromise survival or local control.