Nail Melanoma In Situ: Clinical, Dermoscopic, Pathologic Clues, and Steps for Minimally Invasive Treatment

BACKGROUNDNail 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. OBJECTIVEDetailed evaluation of clinical and dermoscopy features and description of conservative surgery of in situ NUM. METHODSRetrospective study of in situ NUM diagnosed and treated with conservative surgical management in the authorsʼ center from 2008 to 2013. RESULTSSix cases of NUM were identified2 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. CONCLUSIONNail 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.