Query: nail melanoma

title: Functional surgery versus amputation for in situ or minimally invasive nail melanoma: A meta analysis.
abstract: Evidence on whether functional surgery is not inferior to amputation for the treatment of in situ or minimally invasive (Breslow thickness =0.5 mm) nail melanoma is limited.  To investigate the difference in local recurrence between the 2 interventions for in situ or minimally invasive nail melanoma using available published studies.  We performed systematic search on Pubmed, EMBASE, Cochrane library, trial registers, and grey literature databases from inception to June 28, 2018. We included observational studies with at least 5 in situ or minimally invasive nail melanoma cases. Main outcome was local recurrence.  Odds ratio synthesized from 5 studies including 110 patients (89 functional surgery and 21 amputation) was 1.57 (95% confidence interval: 0.31 8.00) LIMITATIONS Small sample size and possible inter study heterogeneity.  Our meta analysis revealed no difference in local recurrence between the 2 interventions. Considering the functional deficit after amputation, conservative surgery should be the treatment of choice for in situ or minimally invasive nail melanoma.

title: Descriptive survival study of nail melanoma patients treated with functional surgery versus distal amputation

title: In Response to "Descriptive Survival Study of Nail Melanoma Patients Treated With Functional Surgery vs Distal Amputation"

title: Management and treatment of nail melanoma.
abstract: An early and prompt nail apparatus melanoma (NAM) diagnosis is associated with less invasive surgical procedures and a better patient's prognosis. The diagnostic delay may be related both to the clinical misinterpretations and to errors in the diagnosing process. Biopsy techniques have been adequately described by nail experts, but the two main problems in the correct choice of the biopsy are probably related to the difficulty in performing surgery in the nail unit and the risk of permanent nail dystrophy.  We retrospectively investigated anamnestic data and diagnostic procedures that all NAM patients referred from 1992 to January 2014, with the following objectives: 1) to evaluate the initial misdiagnoses and quantify the diagnostic delay; 2) to correlate the type of the initial biopsy with the achievement of the correct diagnosis.  In our cases it was easier for a non dermatologist to misdiagnose NAM for a benign inflammatory disease. Dermatologist instead were easier to refer patients to a tertiary center for nail diseases.  In the presence of a NAM clinical and dermoscopic suspicion, longitudinal biopsy is recommended in all cases of nail pigmentation (lateral or median) that is estimated in its width as 3 6 mm, or larger than 6 mm. Regarding therapeutic surgery in our experience disarticulation compared to "functional surgical excision" did not correlate with a better prognosis.

title: Melanoma of the nail apparatus: a systematic review and meta analysis of current challenges and prognosis
abstract: Nail apparatus melanoma (NAM) is a rare dermatologic malignancy. Its prognosis is poor because it is often diagnosed late. However, progression and survival of NAM patients have only been studied among small populations. Early biopsy could help to identify suspicious lesions at a less invasive stage. While surgery is generally seen as the treatment of choice, the extent of excision margins and the use of sentinel biopsy remain debated. This systematic review aims to summarize the treatment procedures and observed prognosis in the literature during the last two decades and present pooled survival and progression rates of NAM by using meta analysis. A systematic review on studies assessing pathology, treatment and prognosis of NAM was carried out up to end of 2018. After evaluation of eligible studies, the main emerging topics were outlined and pooled survival outcomes estimated. A total of 30 articles out of 624 identified records were included for systematic review. Finally, meta analysis of pooled mortality rates including 18 studies was 4.6 x 100 patient years (95% CI: 2.7, 6.8) equivalent to 5 year cumulative survival of 77.0% Additionally, the pooled progression rate based on 17 studies was 6.3 x 100 patient years (95% CI: 4.1, 8.9) with estimated 5 year cumulative progression free survival of 68.5% While the optimal extent of surgical treatment remains debated, prompt biopsy could help to identify early lesions. This is the first study to present pooled survival and progression rates by meta analysis.

title: Nail Melanoma In Situ: Clinical, Dermoscopic, Pathologic Clues, and Steps for Minimally Invasive Treatment
abstract: Nail 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.  Detailed evaluation of clinical and dermoscopy features and description of conservative surgery of in situ NUM.  Retrospective study of in situ NUM diagnosed and treated with conservative surgical management in the authors' center from 2008 to 2013.  Six cases of NUM were identified: 2 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.  Nail 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.

title: Immunohistochemical characterization of benign activation of junctional melanocytes and melanoma in situ of the nail unit
abstract: Immunohistochemical (IHC) stains that distinguish benign, pigmented nail lesions from malignancy are needed. Candidate markers of malignant transformation include p16, HMB45, and Ki 67, with p16 being of particular interest. There is limited knowledge about the spectrum of p16 expression in pigmented lesions, especially junctional melanocytic proliferations of the nail. The objective of this study was to determine if any of these markers demonstrate diagnostic utility in distinguishing between benign activation of junctional melanocytes (BAM) and melanoma in situ (MIS) of the nail unit.

title: The causes of nail apparatus pigmentation presenting to a melanoma screening clinic a prospective study
abstract: Advanced stage primary cutaneous malignant melanoma (PCMM) has a high mortality. PCMM may affect any area of the skin, including the nail apparatus (malignant melanoma or subungual melanoma) Although nail apparatus malignant melanoma (NAMM) is rare, delayed diagnosis carries a poor prognosis.

title: Paediatric melanoma of the nail unit with rapid progression: a case report with dermatoscopic follow up and intraoperative dermatoscopic images
abstract: Paediatric melanoma, usually defined as melanoma occurring in patients younger than 20 years, represents approximately only 1 4 per cent of all melanomas, with an estimated annual incidence rate of nine per million with respect to those aged 15 19 years. The presence of longitudinal melanonychia in a single nail of a child represents a diagnostic challenge for clinicians because worrisome dermatoscopic features of nail matrix melanoma are commonly found in childhood naevi. Nail matrix melanoma is exceedingly rare in this population with only 14 cases reported in the literature.

title: Longitudinal melanonychia: detection and management of nail melanoma.
abstract: Malignant melanoma of the nail confers a higher mortality rate compared to other cutaneous melanomas, which is often attributable to delayed diagnosis. Two thirds of nail melanomas present as longitudinal melanonychia (LM) longitudinally oriented brown black bands of pigment in the nail plate. This article delineates the appropriate clinical approach toward evaluation and management of a patient with longitudinal melanonychia, which includes determining risk factors for melanoma, recognizing scenarios in which biopsy is indicated, selecting the appropriate biopsy technique, and managing a patient in whom the diagnosis of nail melanoma has been made.