Assessing patient outcomes after digit-sparing en bloc surgery of nail apparatus melanoma in situ using two validated surveys

Knackstedt, Thomas; Baltz, Julia O.; Wilmer, Erin N.; Jellinek, Nathaniel J.

doi:10.1016/j.jaad.2019.07.053

Cited by 8 publications

(9 citation statements)

References 6 publications

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“…In addition, SIH may provide better cosmetic outcome with less hyperpigmentation than FTSG ( 6 ). A recent survey assessing patient outcome after digit-sparing conservative surgery of NM in situ revealed a high overall satisfaction score ( 14 ). Considering the mean DASH score of 31.3 after ray amputation and 21.7 after digit amputation ( 15 ), the current study revealed a better score, with a mean of 11.6 ±7.1 after functional surgery with SIH.…”

Section: Discussionmentioning

confidence: 99%

Secondary Intention Healing After Functional Surgery for in Situ or Minimally Invasive Nail Melanoma

Hur²,

Cho³

et al. 2020

Acta Derm Venereol

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Section: Discussionmentioning

confidence: 99%

Secondary Intention Healing After Functional Surgery for in Situ or Minimally Invasive Nail Melanoma

Hur²,

Cho³

et al. 2020

Acta Derm Venereol

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“…This study by Knackstedt et al, focusing on subungual melanoma, corroborated our results that patients are able to maintain functionality after digit-sparing treatment. 17 Interestingly, our series trends toward a functionality benefit, although our study is underpowered to stratify this benefit between hand dominance and specific digit. It is presumable to think that patients would gain greater functional benefit when attempting to spare the dominant thumb when compared with a nondominant index finger.…”

Section: Discussionmentioning

confidence: 79%

Reconstruction after Mohs Surgery for Digit Melanoma: Description of Techniques and Postoperative Limb Function

Wink

Rhemtulla

Fix

et al. 2024

Journal of Hand and Microsurgery

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Introduction Mohs surgery and reconstruction has enabled tissue-preserving resection of cutaneous malignancies. The goal of our case series evaluation is to present reconstructive techniques and functional outcomes in patients undergoing digit-sparing treatment for primary melanoma. Materials and Methods A chart review was performed to identify consecutive patients undergoing Mohs surgery and reconstruction for melanoma of the digits. Quality of life (QOL) survey was performed to assess function after the procedure. Results Thirty-two patients (13 hand, 19 foot, Age: 65.03 +/–17.78 years) who were undergoing Mohs surgery were identified. No recurrence was identified with an average follow-up of 16.1 months (1–95 months). The average defect size was 5.79 +/–4.54 cm2. Reconstruction was performed 0–4 days after resection. The most common techniques included full-thickness skin graft (FTSG) (N = 7), collagen matrix + FTSG (N = 4), and volar advancement flap (N = 7). The reconstructive technique choice appears correlated with defect size (p = 0.0125). Neuro-QOL upper extremity survey results showed a difference that approached statistical significance between patients who underwent digit-sparing treatment (n = 7) versus direct to amputation controls (n = 5) (p = 0.072). No survey differences between digit-sparing treatment (n = 10) and amputation (n = 8) were identified in the lower extremity (p = 0.61). Conclusion Our results show digit-sparing treatment can confirm clear surgical margins and a trend toward improvement in upper extremity function compared with immediate amputation.

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“…This observation remains true even when the entire nail unit is resected with permanent loss of the nail. 76 Reality Amputation significantly affects functional status and should only be performed if complete removal of the primary tumor cannot be achieved using more conservative methods.…”

Section: Myth 6: the Functional Impairment Of Amputation Is Minimalmentioning

confidence: 99%

A Call for Evidence-Based Conservative Management of Nail Unit Malignancies

Stiff

Jellinek

Knackstedt

2022

Plastic &Amp; Reconstructive Surgery

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Summary: Nail unit squamous cell carcinoma and melanoma are the most common malignancies of the nail apparatus. Compared to their cutaneous counterparts, they are diagnosed later and perceived as more aggressive. This may result in overzealous management, including radiographic imaging with poor sensitivity and specificity, interventional nodal staging by sentinel lymph node biopsy, amputation over digit-sparing tumor resections, and elaborate reconstructions after tumor extirpation. In this review article, the authors evaluate the evidence behind several misconceptions in nail malignancy management and provide evidence-based guidance for more conservative care.

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Assessing patient outcomes after digit-sparing en bloc surgery of nail apparatus melanoma in situ using two validated surveys

Cited by 8 publications

References 6 publications

Secondary Intention Healing After Functional Surgery for in Situ or Minimally Invasive Nail Melanoma

Secondary Intention Healing After Functional Surgery for in Situ or Minimally Invasive Nail Melanoma

Reconstruction after Mohs Surgery for Digit Melanoma: Description of Techniques and Postoperative Limb Function

A Call for Evidence-Based Conservative Management of Nail Unit Malignancies

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