ABSTRACT Background: Standard treatment for subungual melanoma is wide
local excision including digit amputation in order to obtain safety margins.
Level of amputation has been discussed in order to achieve appropriate
oncological results along with preservation of limb function wherein local
excision of subungual melanoma in situ without amputation is an option. Methods: We report two cases of subungual melanoma in situ treated by using a conservative approach. Both cases were
treated with local excision with the resected tumor defect covered with an
artificial dermis, Matriderm?. One case was of a 65-year-old male with a left
thumb subungual melanoma in situ and
another of a 41-year-old female with the same type of melanoma in the left
hallux. Full-thickness skin graft was used for reconstruction after 7 weeks
from the first surgery in the latter, and in the former case re-epithelization
occurred within 90 days after surgery. To date, no clinical signs of recurrence
have been found, and finger/toe functions were completely preserved with a
minimized scar and little graft bed sensitivity. Follow-up time is two years
and ten months for the left thumb case, and one year and six months for the
left hallux subungual melanoma in situ. Conclusion: We present two cases of subungual melanoma in situ treated with digit sparing
surgery including excision of the periosteum followed by the use of an
artificial dermal template to guarantee coverage of the tumor bed defect,
providing good functional and cosmetic outcome.
Cite this paper
Campagnari, M. , Carneiro, H. , Jafelicci, A. , da Silva Reis, H. , Gomes, E. , Bertolli, E. and Neto, J. (2017) Conservative Surgery for Subungual Melanoma In Situ Using Matriderm®. Journal of Cancer Therapy, 8, 861-866. doi: 10.4236/jct.2017.810075.
 Brodland, D. (2001) The Treatment of Nail Apparatus Melanoma with Mohs Micrographic Surgery. Dermatologic Surgery, 27, 269-273.
 Eedy, D. (2003) Surgical Treatment of Melanoma. British Journal of Dermatology, 149, 2-12. https://doi.org/10.1046/j.1365-2133.149.s64.8_65.x
 Phan, A., et al. (2006) Acral Lentiginous Melanoma: A Clinicoprognostic Study of 126 Cases. British Journal of Dermatology, 155, 561-569.
 Cochran, A., et al. (2014) Subungual Melanoma. Plastic and Reconstructive Surgery, 134, 259-273. https://doi.org/10.1097/PRS.0000000000000529
 Park, S., et al. (2015) Scattered Atypical Melanocytes with Hyperchromatic Nuclei in the Nail Matrix: Diagnostic Clue for Early Subungual Melanoma In Situ. Journal of Cutaneous Pathology, 43, 41-52. https://doi.org/10.1111/cup.12634
 Chow, W., et al. (2013) In Situ Subungual Melanoma: Digit Salvaging Clearance. Journal of Plastic, Reconstructive & Aesthetic Surgery, 66, 274-276.
 Park, K., Blessing, K. and Kernohan, N. (1992) Surgical Aspects of Subungual Malignant Melanomas. Annals of Surgery, 216, 692-695.
 Clarkson, J., et al. (2002) Subungual Melanoma In Situ: Two Independent Streaks in One Nail Bed. British Journal of Plastic Surgery, 55, 165-167.
 Tufaro, A., Buck, D. and Fischer, A. (2007) The Use of Artificial Dermis in the Reconstruction of Oncologic Surgical Defects. Plastic and Reconstructive Surgery, 120, 638-646. https://doi.org/10.1097/01.prs.0000270298.68331.8a
 Duarte, A., et al. (2010) Nail Matrix Melanoma In Situ: Conservative Surgical Management. Dermatology, 220, 173-175. https://doi.org/10.1159/000266038
 Wagner, A., et al. (2007) Subungual Melanoma. Annals of Plastic Surgery, 59, 344-348. https://doi.org/10.1097/SAP.0b013e31802c54db