Abstract
Background: Standard treatment for subungual melanoma is wide local excision including digit amputation in order to obtain safety margins. Level of amputation has been discussed in order to achieve appropriate oncological results along with preservation of limb function wherein local excision of subungual melanoma in situ without amputation is an option. Methods: We report two cases of subungual melanoma in situ treated by using a conservative approach. Both cases were treated with local excision with the resected tumor defect covered with an artificial dermis, Matriderm?. One case was of a 65-year-old male with a left thumb subungual melanoma in situ and another of a 41-year-old female with the same type of melanoma in the left hallux. Full-thickness skin graft was used for reconstruction after 7 weeks from the first surgery in the latter, and in the former case re-epithelization occurred within 90 days after surgery. To date, no clinical signs of recurrence have been found, and finger/toe functions were completely preserved with a minimized scar and little graft bed sensitivity. Follow-up time is two years and ten months for the left thumb case, and one year and six months for the left hallux subungual melanoma in situ. Conclusion: We present two cases of subungual melanoma in situ treated with digit sparing surgery including excision of the periosteum followed by the use of an artificial dermal template to guarantee coverage of the tumor bed defect, providing good functional and cosmetic outcome.
Highlights
Standard treatment for subungual melanoma is wide local excision including digit amputation in order to obtain safety margins
We present two cases of subungual melanoma in situ treated with digit sparing surgery including excision of the periosteum followed by the use of an artificial dermal template to guarantee coverage of the tumor bed defect, providing good functional and cosmetic outcome
Digit amputation has been the standard treatment to obtain the safety margins established by the depth of tumor invasion (Breslow) as well as to prevent recurrence and metastasis
Summary
Delayed diagnosis frequently results in poor prognosis together with advanced stage of subungual melanoma, requiring amputation of the affected digit [5] In this manner, digit amputation has been the standard treatment to obtain the safety margins established by the depth of tumor invasion (Breslow) as well as to prevent recurrence and metastasis. Even though no standard surgical treatment has been established for this type of melanoma, radical surgery in a narrow surgical margin with the total thickness skin graft is generally performed. After this kind of procedure (total-thickness skin graft) or second intention healing, patients often complain about cutaneous sensitivity and scar pain. Use of a biosynthetic dermal substitute may decrease donor-site morbidity and help improve limb function and scar quality
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