SUBUNGUAL MELANOMA - AN 18-YEAR REVIEW

Background. Subungual melanoma is a rare lesion comprising 1% to 3% of all melanoma cases. Methods. Records of twenty-two patients with subu ngual melanoma treated at Roswell Park Cancer Institute during the per iod September 1971 to September 1989 were reviewed in a retrospective manner. Most common sites of involvement were the great two on the foo t (n = 7), the thumb (n = 4), and the index (n = 3) and ring fingers ( n = 3) on the hand. Common signs included pigmentation of the nail bed , nail loss, and nail destruction. Results. Thickness of the lesion co uld be determined in 10 patients. All four patients with lesions 1.0 m m and thinner at th time of biopsy were alive and disease free at 19, 20, 55, and 78 months, whereas three of six patients with lesions thic ker than 1.0 mm were dead at 15, 51, and 56 months. Patients with ulce rated lesions had an estimated 5-year survival rate of 39% as compared with 80% for the group without ulceration. Seven patients underwent f inger amputations distal to the metacarpophalangeal joint, and none ex perienced local recurrence. Four amputations were just proximal to the distal interphalangeal joint, and three were just proximal to the pro ximal interphalangeal joint. One of these patients died of metastatic melanoma at 56 months, and the other six were alive and disease free a t 13, 19, 20, 32, 72, and 78 months from the time of diagnosis. Conclu sions. More distal amputations of subungual melanomas of the had prese rve function and do not compromise survival or local control.