Clinical and histopathologic characteristics of early lesions of subungual malignant melanoma

Saida, Toshiaki; Ohshima, Yoko

doi:10.1002/1097-0142(19890201)63:3<556::aid-cncr2820630326>3.0.co;2-q

Cited by 102 publications

(77 citation statements)

References 12 publications

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“…The early lesion of nail apparatus melanoma presents as a longitudinal brown lines on the nail. 2 The present case had a dome-shape nodule on the hyponychium of the big toe without melanonychia, suggesting that atypical melanocytes may appear at the distal nail bed or the hyponychium of the big toe. To our knowledge, only three cases of melanoma on the big toe including the present case without melanonychia have been reported from Japan.…”

mentioning

confidence: 55%

Nodular melanoma on the hyponychium: Clinical and dermoscopic features

Yamamoto

Harada

Ando

et al. 2014

The Journal of Dermatology

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Dermoscopy is an essential tool for diagnosis of pigmented skin lesions. 1 Here, we provide a case of nodular melanoma (NM), in which dermoscopy demonstrated rare features of blue-gray globules and nodular melanoma or Spitz nevus was suspected. A 70-year-old man was referred to our clinic with a nodule on the right big toe since 4 months prior. He had experienced no trauma on the toe. His clinical examination revealed a 12 mm 9 7 mm, symmetrical, dome-shaped, well-circumscribed and reddish-brown nodule on the hyponychium of the big toe. The lesion was accompanied by blue to black dots on the surface (Fig. 1a). Dermoscopic examination demonstrated thick negative pigment networks and irregular brown to blue-gray dots/globules (Fig. 1b). The dots/ globules, the size and density of which were varied, were entirely distributed on surface of the nodule and large and dense globules tended to be well recognized at the margin of this lesion. Moreover, the central area of the lesion showed a structureless white area with blue-gray dots. Although Spitz nevus, other mesenchymal or epithelial tumors could be diagnosed from clinical presentation, the dermoscopic findings suggestive of melanoma. Therefore, we performed resection of the nodule. Histopathological examination showed sheet-like proliferation of tumor cells with atypical nuclei from the papillary dermis to subcutaneous tissue, formation of irregular nests of atypical melanocytes in the epidermis and solitary atypical melanocytes throughout the epidermis (Fig. 1c,d). Melanophages, degenerated tumor cells and dermal fibrosis were observed in the central portion of nodule, indicating the regression of melanoma (Fig. 1e). The tumor cells of the nodule were stained positively with HMB-45 and S-100 and tumor thickness was 6 mm. Based upon these findings, a diagnosis of NM was established. A computed tomography scan revealed no metastasis but a sentinel lymph node biopsy detected a micrometastasis in an inguinal lymph node, suggesting a tumor grade of pT4a, N1a, M0 (stage IIIA). We additionally performed an amputation of the big toe and a radical dissection of lymph nodes. The pathological sample showed no atypical melanocytes in the nail matrix. Most malignant melanoma on the toe occurs in the nail matrix. The early lesion of nail apparatus melanoma presents as a longitudinal brown lines on the nail. 2 The present case had a dome-shape nodule on the hyponychium of the big toe without melanonychia, suggesting that atypical melanocytes may appear at the distal nail bed or the hyponychium of the big toe. To our knowledge, only three cases of melanoma on the big toe including the present case without melanonychia have been reported from Japan. 3 To date, some dermoscopic findings including blue-white veil, atypical vascular pattern and homogeneous blue pigmentation have been reported to be suggestive for NM. 4 In this case, the dermoscopy demonstrated entirely distributed dots/globules, of which the size and density varied, with thick negativepigment networks. These features...

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confidence: 55%

Nodular melanoma on the hyponychium: Clinical and dermoscopic features

Yamamoto

Harada

Ando

et al. 2014

The Journal of Dermatology

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“…Two studies reporting no differences in the rates of survival or recurrence when comparing local excision to amputation contain fewer than 10 patients. 22,23 Banfield et al reported a 79% rate of 5-year survival with local excision versus 41% with amputation in a series of 105 patients, but they noted that the patients who had local excision had lesions with an average Breslow thickness of 3.2 mm as compared with an average Breslow thickness of 6.1 mm in those that had amputation. 24 In a study of 62 patients, Moehrle et al reported no significant difference in the rate of survival and a decreased rate of recurrence with local excision versus amputation in or proximal to the DIP joint, but they similarly reported a greater mean Breslow thickness in the amputation group.…”

Section: Evidence For Local Excision Versus Amputation In Subungual Mmentioning

confidence: 99%

“…Indeed, the thorough literature review of this topic performed for the purposes of this article identified fewer than 900 cases of subungual melanoma in the literature for which both treatment and outcome were specified. With an estimated incidence of 0.1 cases per 100,000 persons per year, 24 SMM represents approximately 1% of all cutaneous melanoma, 21,24 but disproportionately affects older patients 16 and those of Asian 22 and African 26 descent, making these populations potential focuses for future research.…”

Section: Directions For Future Researchmentioning

confidence: 99%

Subungual Malignant Melanoma

Martín

English

Goitz

2011

The Journal of Hand Surgery

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“…Overall 5-year survival rates range from 20% to 50%. Therefore, early diagnosis is important and subungual melanoma should be considered for all slowgrowing and non-healing subungual and periungual lesions, whether it is pigmented or not 2,3,10 .…”

Section: Case Reportmentioning

confidence: 99%

“…They account for a greater proportion of melanomas in nonwhite persons. One study in a Japanese population found that more than 30% of melanomas involved the digits 3 . Approximately 15 to 25% of cases of subungual melanoma are amelanotic.…”

Section: Introductionmentioning

confidence: 99%