Goettmann S, Moulonguet I, Zaraa I
Dermatology, Dermatology Office, Paris, France.
Pathological Anatomy, Pathology Office, Paris, France.
J Eur Acad Dermatol Venereol. 2018 Dec;32(12):2300-2306. doi: 10.1111/jdv.15124. Epub 2018 Jun 27.
Nail unit melanoma (NUM) is a rare melanoma variant, usually associated with a poor prognosis because of a delayed diagnosis. Few data are available concerning the management and long-term outcome of in situ NUM.
To use a large cohort to provide comprehensive patient data and long-term follow-up information. This will serve to investigate distinctive epidemiological, clinical and histological features of in situ NUM. To report treatment modalities, assess conservative surgery and evaluate its long-term safety.
Patients with confirmed diagnosis of in situ NUM were retrospectively reviewed. Demographics, clinical presentation, therapeutic data and follow-up were analysed.
Sixty-three cases of in situ NUM were identified as follows: 44 were women (70%), with a mean age of 51 years. The mean duration of symptoms prior to consultation was 4.3 years [range 3 months-28 years]. Clinically, with 58 cases, i.e. (92%) longitudinal melanonychia was the most common clinical presentation. The thumb was the most affected digit, being afflicted in 28 cases: 44%. Medical history found a widening and/or recent darkening of the melanonychia in 46 cases (82%). The treatment consisted of, respectively, 56 En bloc excisions of the nail apparatus 89% of the patients we studied, and seven amputations of the distal phalanx. During the follow-up period (mean: 10 years), two patients presented in situ recurrences.
The recognition of a NUM at an in situ stage allows early treatment and curing of this tumour. At this early stage, a 'functional surgery' is a rational approach with an excellent oncologic safety.
甲单位黑色素瘤（NUM）是一种罕见的黑色素瘤变体，由于诊断延迟，通常预后较差。关于原位NUM的管理和长期结果的数据很少。
使用一个大型队列提供全面的患者数据和长期随访信息。这将有助于研究原位NUM独特的流行病学、临床和组织学特征。报告治疗方式，评估保守手术并评估其长期安全性。
对确诊为原位NUM的患者进行回顾性研究。分析人口统计学、临床表现、治疗数据和随访情况。
共确定63例原位NUM患者，具体如下：44例为女性（70%），平均年龄51岁。就诊前症状的平均持续时间为4.3年[范围3个月至28年]。临床上，58例（92%）纵向黑甲是最常见的临床表现。拇指是最常受累的手指，28例（44%）受累。病史显示46例（82%）黑甲变宽和/或近期变黑。治疗方法分别为56例（占我们研究患者的89%）整块切除甲器，7例远端指骨截肢。在随访期间（平均10年），2例患者出现原位复发。
原位阶段识别NUM可使该肿瘤得到早期治疗和治愈。在这个早期阶段，“功能性手术”是一种合理的方法，具有出色的肿瘤学安全性。
