title: Nail melanoma in situ: clinical, dermoscopic, pathologic clues, and steps for minimally invasive treatment.
abstract: BACKGROUND
  Nail unit melanoma (NUM) is a variant of acral lentiginous melanoma. The differential diagnosis is wide but an acquired brown streak in the nail of a fair-skinned adult person must be considered a potential melanoma. Dermoscopy helps clinicians to more accurately decide if a nail apparatus biopsy is necessary.
  
  
  OBJECTIVE
  Detailed evaluation of clinical and dermoscopy features and description of conservative surgery of in situ NUM.
  
  
  METHODS
  Retrospective study of in situ NUM diagnosed and treated with conservative surgical management in the authors' center from 2008 to 2013.
  
  
  RESULTS
  Six cases of NUM were identified: 2 male and 4 female patients, age range at diagnosis of 44 to 76 years. All patients underwent complete nail unit removal with at least 6-mm security margins around the anatomic boundaries of the nail. The follow-up varies from 4 to 62 months.
  
  
  CONCLUSIONS
  Nail unit melanomas pose a difficult diagnostic and therapeutic challenge. Wide excision is sufficient, whereas phalanx amputation is unnecessary and associated with significant morbidity for patients with in situ or early invasive melanoma. Full-thickness skin grafting or second-intention healing after total nail unit excision is a simple procedure providing a good functional and cosmetic outcome.
authors.affiliation: *Centro de Dermatologia Epidermis, Instituto CUF, Porto, Portugal; †Faculty of Medicine, University of Porto, Portugal; ‡Department of Dermatology, Inselspital, University of Bern, Bern, Switzerland; §Dermatology Clinic Dermaticum, Freiburg, Germany; ‖Department of Dermatology, University of Ghent, Ghent, Belgium.
authors.forename: Ana F
authors.initials: AF
authors.lastname: Duarte
authors.forename: Osvaldo
authors.initials: O
authors.lastname: Correia
authors.forename: Ana M
authors.initials: AM
authors.lastname: Barros
authors.forename: Filipa
authors.initials: F
authors.lastname: Ventura
authors.forename: Eckart
authors.initials: E
authors.lastname: Haneke
mesh_terms: D000328:Adult; D000368:Aged; D062109:Dermatologic Surgical Procedures; D046169:Dermoscopy; D005260:Female; D006801:Humans; D018327:Hutchinson's Melanotic Freckle / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D009260:Nail Diseases / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000473:pathology* / Q000601:surgery*