Subungual melanoma - A review of 93 cases with identification of prognostic variables

From 1970 to 1996, 93 patients received diagnoses of subungual melanoma, Fo llowup data were complete on all patients and reviewed with a median durati on of followup of 5.2 years. This study identifies significant clinicopatho logic variables that affect survival and provides the orthopaedic surgeon a ssistance in the early diagnosis and treatment of this lesion, Eight-three percent of patients presented with Stage I disease, whereas 17% had nodal o r distant disease, Fifty-three percent had locally advanced disease at pres entation, Twelve percent of the patients were African-American. Fifty-five percent of the lesions arose on the hands with thumb involvement predominat ing in more than half of these cases, Operative therapy consisted of amputa tion, Elective lymph node dissection was performed in 34 patients (37%) for Stage I tumors of intermediate thickness. Therapeutic node dissection was required in 16 patients (17%) for positive nodes. Five-year survival was 74 % for patients with Stage I disease and 40% for patients with Stage II dise ase, Statistical analysis identified stage at diagnosis, Clark and Wihm's l evel, the patient's race, and the presence of ulceration as prognostic vari ables affecting survival, The diagnosis of subungual melanoma carries a gra ve prognosis and often is misdiagnosed in the early stages, The treatment o f choice is amputation at the appropriate level.