Haddock Nicholas T, Wilson Stelios C, Shapiro Richard L, Choi Mihye
From the *Department of Plastic Surgery, University of Texas Southwestern, Dallas, TX; †Institute of Reconstructive Plastic Surgery and ‡Department of General Surgery, New York University Langone Medical Center, New York, NY.
Ann Plast Surg. 2014 Dec;73(6):640-4. doi: 10.1097/SAP.0b013e318284ecb9.
Subungual melanoma is a rare but lethal form of melanoma. Amputation at the level of the interphalangeal joint or proximal has been described as appropriate surgical management for all stages of subungal melanoma. In cases of subungual melanoma in situ (SMIS), wide local excision can improve functional and aesthetic outcomes. We reviewed our experience of wide local excision for the treatment of SMIS. Between 2003 and 2010, we treated 9 cases of SMIS. We performed a retrospective review of this series looking at the primary outcomes of recurrence or metastasis. Average age was 40 years (range, 5-65 years). Presenting lesions were on the thumb (5) and index finger (4). All patients underwent definitive reconstruction with a combination of full-thickness skin graft (8) and paronychial advancement flap (6). Reexcision was performed when disease-free margins could not be confirmed. To date, there have been no cases of metastasis or local recurrence in any of our 9 patients (mean follow-up time of more than 4 years). Wide local excision can improve functional and aesthetic outcomes with similar success in rates of local recurrence and metastasis when compared to treatment by amputation in SMIS.
甲下黑色素瘤是一种罕见但致命的黑色素瘤形式。指间关节或近端水平的截肢已被描述为甲下黑色素瘤各阶段合适的手术治疗方法。对于原位甲下黑色素瘤（SMIS）病例，广泛局部切除可改善功能和美观效果。我们回顾了我们采用广泛局部切除治疗SMIS的经验。2003年至2010年期间，我们治疗了9例SMIS。我们对该系列进行了回顾性研究，观察复发或转移的主要结局。平均年龄为40岁（范围5 - 65岁）。出现病变的部位在拇指（5例）和食指（4例）。所有患者均采用全厚皮片（8例）和甲沟推进皮瓣（6例）联合进行确定性重建。当无法确认切缘无病时进行再次切除。迄今为止，我们的9例患者中均未出现转移或局部复发情况（平均随访时间超过4年）。与截肢治疗相比，广泛局部切除在SMIS中可改善功能和美观效果，且局部复发和转移率相似。
