Reconstruction of a thumb defect with Integra following wide local excision of a subungual melanoma

Summary We present the case of a patient with a 1.2 mm Breslow thickness subungual melanoma of the thumb who refused the standard treatment of amputation. He underwent a 1 cm wide local excision of the lesion down to bone and the defect was covered with Integra and later grafted. The evidence for increasingly conservative treatment of subungual melanoma is growing. He remains disease free and is left with a fully functional thumb and a good cosmetic result.