What is the role of surgery in the treatment of melanonychia?

Updated: Sep 10, 2018
  • Author: Chris G Adigun, MD, FAAD; Chief Editor: William D James, MD  more...
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Answer

For melanoma in situ, total excision of the nail apparatus or Mohs micrographic surgery is indicated. [41]

For invasive melanoma, amputation of the distal phalanx may be indicated. [42] Albeit controversial, total nail bed excision and reconstruction using a full-thickness graft may be considered. In a large case series, the 5-year survival rates for cutaneous melanoma of the hand versus subungual melanoma treated with a wide local excision was reported as 100% and 80%, respectively. [43] . This was due to a delay in diagnosing subungual lesions, which averaged 3.68 mm in depth versus 1.36 mm for hand melanomas of the cutaneous surface.

Because diagnosis is often delayed in these patients, sentinel lymph node biopsy after surgery may be warranted. [44]


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