Nail Apparatus Melanoma Features Good Survival and Functional Outcome

Close-up of subungual melanoma, toe, toenail
Close-up of subungual melanoma, toe, toenail
Treatment and outcomes of nail apparatus melanoma are outlined in this study that finds a high survival rate—and that conservative treatment yields high patient satisfaction.

The overall 5-year cumulative survival of patients with melanoma of the nail apparatus is 77%, and prompt biopsy may improve this survival rate by assisting in the early identification of lesions. This is according data from a meta-analysis published in the Journal of the European Academy of Dermatology and Venereology.

The analysis included a total of 30 studies consisting of 1340 patients with nail apparatus melanoma. These studies were mostly retrospective, observational, and single-center studies from Australia, the Americas, Asia, and Europe. Researchers examined the pooled overall mortality rate as well as the rate of disease progression in this patient population. The review of the literature also examined frequently reported treatment protocols and observed prognoses of patients with melanoma of the nail apparatus.

In 30% of cases, a nonamputational surgical approach was chosen as the preferred treatment choice for nail apparatus melanoma. Conversely, amputation was chosen in approximately 52.5% (n=700) of cases and included partial or full resection of ≥1 phalanges and/or metacarpal or metatarsal bones. Overall, patients reported satisfaction with conservative treatment followed by skin reconstruction or secondary intention healing. Functional impairment following treatment typically resolved within 1 year after intervention.

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According to the pooled meta-analysis of 18 studies, the mortality rate was 4.6 × 100 patient-years (95% CI, 2.7-6.8), equating to an estimated 5-year cumulative survival of 77.0%. Additionally, the overall progression rate in 17 studies was 6.3 × 100 patient-years (95% CI, 4.1-8.9), corresponding with an estimated 5-year cumulative progression-free survival of 68.5%.

Limitations of the analysis were the inclusion of mostly retrospective, single-center studies as well as the lack of robust cohorts of patients with nail apparatus melanoma.

The investigators suggest that “the earliest possible confirmation of a suspected nail apparatus melanoma by biopsy seems fundamental to allow consideration of a more or less radical surgical method.”

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Lieberherr S, Cazzaniga S, Haneke E, Hunger RE, Seyed Jafari SM. Melanoma of the nail apparatus: a systematic review and meta-analysis of current challenges and prognosis [published online December 2, 2019]. J Eur Acad Dermatol Venereol. doi: 10.1111/jdv.16121