title: Presentation, histopathologic findings, and clinical outcomes in 7 cases of melanoma in situ of the nail unit.
abstract: OBJECTIVE
  To report on the presentation, histopathologic findings, and clinical outcomes for a case series of MIS of the nail apparatus because melanoma in situ (MIS) of the nail unit has not been well characterized in the literature.
  
  
  METHODS
  A division of a tertiary academic center specializing in micrographic excision of cutaneous neoplasms.
  
  
  METHODS
  Surgical records were searched for cases of MIS of the nail unit for the period of January 1, 1997, to December 31, 2002. The patient demographics and disease presentation, treatment, and clinical course were reviewed.
  
  
  RESULTS
  Seven cases of MIS of the nail unit in white patients were identified. Longitudinal melanonychia was present in all cases, but dyspigmentation of the proximal nail fold and onychodystrophy were uncommon. Histopathologic analysis revealed poorly circumscribed proliferations of single cells over nests with variable pagetoid spread. Atypia was variable. Mitotic activity was low. All cases were treated with micrographic surgery. Amputation was avoided in 3 cases and was limited to partial distal interphalangeal amputation in the remainder. Six cases did not recur locally after initial surgical intervention. With an average of 24 months of follow-up, all patients were free of disease.
  
  
  CONCLUSIONS
  Longitudinal melanonychia in a white patient mandates consideration of MIS of the nail unit. Given the nondescript clinical presentation, the threshold for biopsy should be low. The histopathologic findings appear similar to those of MIS in other areas, with asymmetry and poor circumscription predominating. With additional study and further acceptance, micrographically controlled excision has the potential to minimize morbidity. Further investigation is warranted.
authors.affiliation: Department of Dermatology, The University of Texas Southwestern Medical Center at Dallas, 75390-9192, USA.
authors.forename: Whitney A
authors.initials: WA
authors.lastname: High
authors.forename: Robert A
authors.initials: RA
authors.lastname: Quirey
authors.forename: David R
authors.initials: DR
authors.lastname: Guillén
authors.forename: Gloria
authors.initials: G
authors.lastname: Munõz
authors.forename: R Stan
authors.initials: RS
authors.lastname: Taylor
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008545:Melanoma / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D015580:Mohs Surgery / Q000379:methods; D009260:Nail Diseases / Q000473:pathology* / Q000601:surgery; D009367:Neoplasm Staging; D012189:Retrospective Studies; D018570:Risk Assessment; D012494:Sampling Studies; D012878:Skin Neoplasms / Q000473:pathology* / Q000601:surgery; D016896:Treatment Outcome