Subungual Melanoma

Abstract

Subungual melanoma typically presents as a darkened longitudinal stripe under the nail plate; however, this disease is frequently misdiagnosed, which leads to a delay in proper diagnosis. Subsequently, subungual melanoma historically has a relatively poor prognosis compared with other cutaneous melanomas, with the 5-year survival rate ranging between 16 and 80 percent. Historically, these lesions were removed using aggressive amputation. To date, the National Cancer Institute does not have guidelines for the treatment of subungual melanoma. The authors conducted a complete review of all cases within the literature involving amputation and/or wide local excision for the treatment of subungual melanoma. There is currently a trend toward a more conservative approach in treating subungual melanoma; however, the literature does not offer a high level of evidence, and definitive conclusions cannot be drawn. Overall, the studies within the literature involving amputation as the treatment for subungual melanoma could not prove a significant benefit, in terms of prognosis and/or survival, over the more conservative treatment of excision. The collective data imply that melanoma in situ can likely be treated appropriately with wide local excision. The literature lacks randomized, prospective, or comparative studies that would help elucidate whether amputation is superior to a more conservative, digit-sparing approach. Prospective randomized control trials are indicated.