Nail Apparatus Melanoma: Current Management and Future Perspectives

Abstract

Nail apparatus melanoma (NAM) is a rare type of cutaneous melanoma that belongs to the acral melanoma subtype. NAM is managed principally in accordance with the general treatment for cutaneous melanoma, but there is scarce evidence in support of this in the literature. Acral melanoma is genetically different from non-acral cutaneous melanoma, while recently accumulated data suggest that NAM also has a different genetic background from acral melanoma. In this review, we focus on recent advances in the management of NAM. Localized NAM should be surgically removed; amputation of the digit and digit-preserving surgery have been reported. Sentinel lymph node biopsy can be considered for invasive NAM for the purpose of accurate staging. However, it is yet to be clarified whether patients with metastatic sentinel lymph nodes can be safely spared completion lymph node dissection. Similar to cutaneous melanoma, immune checkpoint inhibitors and BRAF/MEK inhibitors are used as the first-line treatment for metastatic NAM, but data on the efficacy of these therapies remain scarce. The therapeutic effects of immune checkpoint inhibitors could be lower for NAM than for cutaneous melanoma. This review highlights the urgent need to accumulate data to better define the optimal management of this rare melanoma.

Various Free Flap Reconstruction Techniques after Hand and Foot Melanonychia Ablation: A Case Series

“…The diagnosis and management of melanonychia is still debated. On physical examination, physicians should search for the number, color, edge and width of bands, nodularity, and nail deformities in melanonychia [1,2]. Another approach for diagnosis is through dermatoscopy and biopsy.…”

“…For the usual melanonychia patient, we do not apply the nail bed biopsy process. But, if Hutchinson's sign (periungal pigmentation beyond the nail bed), the well-known clinical hallmark of subungual melanoma, or lines with irregular spacing and disruption of parallelism are found on dermoscopic examination, we perform punch biopsy to confirm subungal melanoma [2][3][4]. It is unestablished what percentage of melanonychia underwent malignant transformation.…”

“…Possible causes include nail melanoma, nevus, sunspots, racial and friction pigmentation, subungual hemorrhage, and bacterial or fungal infections. It is sometimes quite difficult to differentiate between melanonychia and subungal melanoma [2]. Late diagnosis of subungal melanoma prognosis is usually rather poor.…”

“…However, histologic features of early melanoma remain a histologic challenge because they can be isolated. The literature discusses the management of melanonychia, but when in doubt, the surgeon should perform a gross examination of the lesion [2,3]. Also, the nail matrix biopsy procedure itself poses a high risk of postoperative split nail and other nail deformity.…”

A Misdiagnosed Case of Malignant Melanoma in an Infected Nail: A Case Report

“…Subungual melanoma is a rare variant of acral lentiginous melanoma, a malignant melanoma arising from palms and soles. Subungual melanoma originates from the nail matrix [ 1 ]. The subungual form comprises 0.7-3.5% of all cutaneous melanomas, accounting for 10-23% in Asians, 25% in Africa-Americans, and 0.18-2.8% in Europeans [ 1 , 2 ].…”