Mimical reconstruction and aesthetic repair of the nail after resection of subungual melanocytic nevus

Wenpeng Xu,Yong Hu,Songhua Cao,Xiucun Li,Ning Zhang

doi:10.1186/s12893-021-01423-9

Abstract

BackgroundThis study aimed to report the outcomes of mimical reconstruction and aesthetic repair of the nail.MethodsWhen the pigmented bands were more than 1/2 the width of the whole nail, mimical reconstruction of the nail was performed, with a lateral toe pulp island flap covering the wound via the subcutaneous channel. If the pigmented bands were 1/4 to 2/5 the width of the entire nail, aesthetic repair of the nail was carried out by split-thickness excision under a microscope.ResultsThe average age of patients at the time of surgery was 14.5 years. Five patients had lesions on their toes, while three had lesions on their fingers. There were no post-operative complications. All toenails of the five patients who had undergone mimical reconstruction exhibited a well-settled flap. The nails of the three patients who underwent aesthetic repair displayed no nail malnutrition or deformity, and all nails had an aesthetic appearance.ConclusionsBoth mimical reconstruction and aesthetic repair of the nail following resection of subungual melanocytic nevus are reliable and feasible. The “like tissue” repairs of complex nail defects appear to be satisfactory. All patients had excellent aesthetic outcomes.Level of evidenceV

Highlights

Subungual melanocytic nevi, which always appeared as melanonychia [1, 2], are caused by the proliferation of melanocytes in the nail matrix and nail bed [3], and are usually junctional nevi and rarely compound nevi [4, 5]
The inclusion criteria of the patients with subungual pigmented lesions were as follows: (1) pigmented bands that were more than 3 mm or 1/4 of the whole nail width, (2) dark brown to black color, (3) more than a one-year interval from onset to surgical resection, (4) progressive increase in the width of the pigmented bands within one year, and (5) absence of pigmentation on the adjacent skin (Hutchinson’s sign)
Patients with narrow pigment bands of less than 3 mm, blurred surrounding borders, nail dystrophy, and/or ulceration were excluded from this study

Summary

Introduction

Subungual melanocytic nevi, which always appeared as melanonychia [1, 2], are caused by the proliferation of melanocytes in the nail matrix and nail bed [3], and are usually junctional nevi and rarely compound nevi [4, 5]. According to the diagnostic criteria of the subungual melanoma [2, 6] and the consensus on melanonychia nail plate dermoscopy [7], surgical resection of subungual melanocytic nevi is performed when the width of the subungual pigmented bands exceeds 3 mm. There is currently no consensus on the treatment of subungual melanocytic nevi with pigmented bands. This study aimed to report the outcomes of mimical reconstruction and aesthetic repair of the nail

Objectives

Methods

Results

Discussion

Conclusion