Delayed Reconstruction for the Non-Amputative Treatment of Subungual Melanoma.
BACKGROUND
In cases of early stage subungual melanoma (SUM), conservative treatment with non-amputative wide excision of the nail unit and subsequent skin graft is preferred over amputation to preserve the involved digit.


OBJECTIVE
We report a series of patients with SUM treated with conservative surgery and suggest an effective supplementary treatment process.


METHODS
We retrospectively reviewed 10 patients (2 males, 8 females) who were diagnosed with in situ or minimally invasive SUM on the first biopsy and underwent non-amputative wide excision of the nail unit. All patients underwent secondary intention healing during the histopathological re-evaluation of the entire excised lesion, and additional treatment was administered according to the final report.


RESULTS
In two of 10 patients, amputation was performed because of the detection of deep invasion (Breslow thickness: 4.0, 2.3 mm) from the final pathologic results, which differed from the initial biopsy. In six patients who received delayed skin graft, the mean total time required for complete healing after secondary intention healing and the skin graft was 66.83±15.09 days. As a result of this delayed skin graft, the final scarring was similar to the original shape of the nail unit, scored between 5 and 10 on a visual analogue scale. Most patients were satisfied with this conservative surgery except one patient, who had volar portion involvement and received an interpolated flap instead of a skin graft.


CONCLUSIONS
Our treatment process can reduce the risk of incomplete resection and improve cosmetic outcomes in patients with SUM.
Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea.
Byung Ho
BH
Oh
Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea.
Hong Sun
HS
Jang
Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea.
Jungsoo
J
Lee
Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea.
Min Ju
MJ
Choi
Department of Dermatology, Yonsei University Health System, Seoul, Korea.
Kyoung Ae
KA
Nam
Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea.
Kee Yang
KY
Chung
Amputation; Non-amputative wide excision; Secondary intention healing; Skin graft; Subungual melanoma