Nail Apparatus Melanoma: Experience of 10 Years in a Single Institution

Abstract

Background: Nail apparatus melanoma (NAM) is rare. The higher mortality reported in the literature is most likely due to advanced disease associated with delayed diagnosis and treatment. Objective: All patients diagnosed with NAM were followed at a single reference center during a period of 10 years, with emphasis on dermatological and histological findings. Clinical outcomes were included. Methods: A retrospective review of medical records, photographs, and histopathological examination. Results: 73.7% of the patients were female and their mean age was 47 years. Caucasian and African-American patients had a similar incidence (47.4%). There was only 1 Asian patient in this study (5.3%). All patients presented with nail plate pigmentation. The mean prediagnosis duration was 33 months. A total of 63.2% patients had in situ melanoma and an average Breslow index of 2.18 mm in invasive cases. Fifteen patients underwent conservative surgery and 3 underwent phalanx amputation. All patients survived, and 4 have had more than a 5-year follow-up. Conclusion: In situ lesions showed longitudinal bands or total melanonychia with no nail dystrophy. Invasive cases presented with dystrophic lesions (longitudinal splitting of the nail). Conservative surgery provides a good option without worsening the prognosis. All dermatologists should be aware of early signs of NAM, since prognosis depends on early treatment.