title: Conservative surgical management of subungual (matrix derived) melanoma: report of seven cases and literature review.
abstract: BACKGROUND
  Subungual melanoma (SUM) is a rare entity, comprising approximately 0·7-3·5% of all melanoma subtypes. SUM histopathologically belongs to the acral lentiginous pathological subtype of malignant melanoma. Its diagnosis is helped by dermoscopy but pathological examination of doubtful cases is required. Classical management of SUM is based on radical surgery, namely distal phalanx amputation. Conservative treatment with nonamputative wide excision of the nail unit followed by a skin graft has been insufficiently reported in the medical literature even though it is performed in many centres.
  
  
  OBJECTIVE
  To report a series of patients with in situ or minimally invasive SUM treated by conservative surgery, to investigate the postoperative evolution and to evaluate the outcome with a review of the literature.
  
  
  METHODS
  We performed a retrospective extraction study from our melanoma register of all patients with in situ and minimally invasive SUM treated with conservative surgery in the University Hospital Department of Dermatology, Lyon, France from 2004 to 2009. The patient demographics, disease presentation, delay to diagnosis, histopathology and postoperative evolution were reviewed.
  
  
  RESULTS
  Seven cases of SUM treated as such were identified in our melanoma database. All cases had a clinical presentation of melanonychia striata. The mean delay to diagnosis was 2years. Surgical excision of the entire nail unit with a 5-10mm safety margin without bone resection followed by full-thickness skin graft taken from the arm was performed in all cases. No recurrence was observed with a mean follow-up of 45months. Functional results were found satisfactory by all patients and their referring physicians. Sixty-two other cases have been found in the literature and are also discussed.
  
  
  CONCLUSIONS
  Conservative surgical management in patients with in situ or minimally invasive SUM is a procedure with good cosmetic and functional outcome and, in our cases as well as in the literature, the prognosis is not changed.
authors.affiliation: Department of Dermatology, Claude Bernard University, Hôpitaux de Lyon, Centre Hopitalier Lyon Sud, 69495 Pierre Bénite Cedex, France.
authors.forename: N
authors.initials: N
authors.lastname: Sureda
authors.forename: A
authors.initials: A
authors.lastname: Phan
authors.forename: N
authors.initials: N
authors.lastname: Poulalhon
authors.forename: B
authors.initials: B
authors.lastname: Balme
authors.forename: S
authors.initials: S
authors.lastname: Dalle
authors.forename: L
authors.initials: L
authors.lastname: Thomas
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000601:surgery*; D008875:Middle Aged; D009260:Nail Diseases / Q000601:surgery*; D012878:Skin Neoplasms / Q000601:surgery*; D016038:Skin Transplantation / Q000379:methods; D013524:Surgical Flaps