Flores-Terry M, Romero-Aguilera G, Mendoza C, Franco M, Cortina P, Garcia-Arpa M, Gonzalez-Ruiz L, Garrido J A
Servicio de Dermatología, Hospital General Universitario de Ciudad Real, Ciudad Real, España.
Servicio de Dermatología, Hospital General Universitario de Ciudad Real, Ciudad Real, España.
Actas Dermosifiliogr (Engl Ed). 2018 Oct;109(8):712-721. doi: 10.1016/j.ad.2018.05.002. Epub 2018 Jul 4.
Amputation is the conventional treatment for malignant subungual tumors (MSUTs), namely, subungual squamous cell carcinoma (SUSCC) and subungual melanoma (SUM). Functional surgery consisting of wide local excision (WLE) of the nail unit can preserve function without modifying prognosis in such cases. We present a series of MSUTs treated with WLE of the nail unit, describe the technique, and review its indications.
Retrospective observational study of MSUTs treated with WLE of the nail unit between 2008 and 2017. The technique consisted of en bloc supraperiosteal excision of the nail unit with a margin of 5mm followed by repair with a full-thickness graft.
Eleven MSUTs were treated in the study period: 7 SUMs (4 in situ; mean thickness, 1.17mm; range, 0-4mm) and 4 SUSCCs (mean thickness, 3.4mm; range, 1.6-6mm). WLE of the nail unit was performed in 9 patients and amputation in 2 patients with invasive SUM. Mean follow-up was 39 months (range, 12-96 months) and no local or regional recurrences were detected. One of the 2 patients who underwent amputation developed metastasis to the brain and died. In our review of the literature, we identified 5 series of patients with SUSCC treated with WLE of the nail unit (105 patients) and 14 series of patients with SUM (243 patients). Based on an analysis of these cases and ours, it would appear that WLE of the nail unit is associated with a very low rate of local recurrence (<7%) and offers better functional and cosmetic outcomes than amputation.
WLE of the nail unit is the treatment of choice for SUSCC without bone involvement and for thin noninvasive SUM (Breslow depth <1mm). It is also feasible in intermediate-thickness SUMs when detailed histologic examination of the margins confirms complete resection. Amputation, by contrast, is the treatment of choice for SUSCCs with bone involvement, very thick SUMs (>4mm), and recurrent tumors.
截肢术是恶性甲下肿瘤（MSUTs）的传统治疗方法，即甲下鳞状细胞癌（SUSCC）和甲下黑色素瘤（SUM）。对于此类病例，由甲单元广泛局部切除（WLE）组成的功能性手术可保留功能且不改变预后。我们报告了一系列接受甲单元WLE治疗的MSUTs，描述了该技术，并回顾了其适应证。
对2008年至2017年间接受甲单元WLE治疗的MSUTs进行回顾性观察研究。该技术包括甲单元的整块骨膜上切除，切缘为5mm，随后用全厚皮片修复。
研究期间共治疗了11例MSUTs：7例SUM（4例原位；平均厚度1.17mm；范围0 - 4mm）和4例SUSCC（平均厚度3.4mm；范围1.6 - 6mm）。9例患者接受了甲单元WLE，2例浸润性SUM患者接受了截肢术。平均随访39个月（范围12 - 96个月），未检测到局部或区域复发。2例接受截肢术的患者中有1例发生脑转移并死亡。在我们对文献的回顾中，我们确定了5个接受甲单元WLE治疗的SUSCC患者系列（105例患者）和14个SUM患者系列（243例患者）。基于对这些病例和我们的病例的分析，似乎甲单元WLE与极低的局部复发率（<7%）相关，并且比截肢术提供更好的功能和美容效果。
对于无骨受累的SUSCC和薄的非浸润性SUM（Breslow深度<1mm），甲单元WLE是首选治疗方法。当切缘的详细组织学检查证实完全切除时，对于中等厚度的SUM也是可行的。相比之下，对于有骨受累的SUSCC、非常厚的SUM（>4mm）和复发性肿瘤，截肢术是首选治疗方法。
