Melanoma of the nail apparatus: a systematic review and meta‐analysis of current challenges and prognosis

Abstract

Nail apparatus melanoma (NAM) is a rare dermatologic malignancy. Its prognosis is poor because it is often diagnosed late. However, progression and survival of NAM patients have only been studied among small populations. Early biopsy could help to identify suspicious lesions at a less invasive stage. While surgery is generally seen as the treatment of choice, the extent of excision margins and the use of sentinel biopsy remain debated. This systematic review aims to summarize the treatment procedures and observed prognosis in the literature during the last two decades and present pooled survival and progression rates of NAM by using meta-analysis. A systematic review on studies assessing pathology, treatment and prognosis of NAM was carried out up to end of 2018. After evaluation of eligible studies, the main emerging topics were outlined and pooled survival outcomes estimated. A total of 30 articles out of 624 identified records were included for systematic review. Finally, meta-analysis of pooled mortality rates including 18 studies was 4.6 9 100 patient-years (95% CI: 2.7, 6.8) equivalent to 5-year cumulative survival of 77.0%. Additionally, the pooled progression rate based on 17 studies was 6.3 9 100 patient-years (95% CI: 4.1, 8.9) with estimated 5-year cumulative progression-free survival of 68.5%. While the optimal extent of surgical treatment remains debated, prompt biopsy could help to identify early lesions. This is the first study to present pooled survival and progression rates by meta-analysis.

Mutation profile of primary subungual melanomas in Caucasians

“…SUM seems to be not related to sun exposure, however, in Australian Melanoma Genome Project UVR signatures on acral melanomas occurred most frequently in subungual parts [11]. Both HFM and SUM seem to have poorer survival outcomes comparing to MMs of the other sites, with 5-year overall survival (OS) in the range 20-60% [22][23][24][25][26][27], although 'Lieberherr's in meta-analysis reports 77% [28]. Poor survival rates are in part as a result of delayed diagnosis since frequent misdiagnosis.…”

Retrospective analysis of nail biopsies performed using the Medicare Provider Utilization and Payment Database 2012 to 2017

“…Aggressive tumor behavior, 7,19,20 poor biopsy technique or failure to biopsy in the earliest disease stages, 7,11,[21][22][23][24][25][26][27][28][29] Because risks factors for SUM are unknown, early detection is the currently only way to potentially improve survival and functionality in these patients. 24,35,36 The incidence of SUM increased 2.04% annually 2012 to 2016, with the nail biopsy rate increasing at a faster rate, except for those performed by dermatologists (8.62% decrease). In addition, the overall number of nail biopsies by dermatologists is low compared to SUM incidence.…”

Melanoma of the Nail Apparatus: An Analysis of Patients’ Survival and Associated Factors

“…The epidemiology of NAM varies among ethnicities, with incidence rates ranging between 0.31 and 1.5% in Caucasian populations [2-4]. The etiology of the disease is multifactorial and includes factors, such as genetics, trauma, exposure to UV light, or family history [3-7]. Diagnostic delay contributes to the poorer prognosis of NAM [3].…”

“…The etiology of the disease is multifactorial and includes factors, such as genetics, trauma, exposure to UV light, or family history [3-7]. Diagnostic delay contributes to the poorer prognosis of NAM [3]. Clinical suspicion requires immediate histopathological clarification of the diagnosis [8].…”