Lee Desiree Ji Re, Arbache Samia Trigo, Quaresma Maria Victória, Nico Marcello Menta Simonsen, Gabbi Tatiana Villas Boas
Department of Dermatology, University of São Paulo, São Paulo, Brazil.
Skin Appendage Disord. 2018 Nov;5(1):20-26. doi: 10.1159/000488722. Epub 2018 Jul 3.
Nail apparatus melanoma (NAM) is rare. The higher mortality reported in the literature is most likely due to advanced disease associated with delayed diagnosis and treatment.
All patients diagnosed with NAM were followed at a single reference center during a period of 10 years, with emphasis on dermatological and histological findings. Clinical outcomes were included.
A retrospective review of medical records, photographs, and histopathological examination.
73.7% of the patients were female and their mean age was 47 years. Caucasian and African-American patients had a similar incidence (47.4%). There was only 1 Asian patient in this study (5.3%). All patients presented with nail plate pigmentation. The mean prediagnosis duration was 33 months. A total of 63.2% patients had in situ melanoma and an average Breslow index of 2.18 mm in invasive cases. Fifteen patients underwent conservative surgery and 3 underwent phalanx amputation. All patients survived, and 4 have had more than a 5-year follow-up.
In situ lesions showed longitudinal bands or total melanonychia with no nail dystrophy. Invasive cases presented with dystrophic lesions (longitudinal splitting of the nail). Conservative surgery provides a good option without worsening the prognosis. All dermatologists should be aware of early signs of NAM, since prognosis depends on early treatment.
甲襞黑色素瘤（NAM）较为罕见。文献报道的较高死亡率很可能归因于与诊断和治疗延迟相关的晚期疾病。
在10年期间，对所有诊断为NAM的患者在单一参考中心进行随访，重点关注皮肤病学和组织学发现。纳入临床结果。
对病历、照片和组织病理学检查进行回顾性分析。
73.7%的患者为女性，平均年龄为47岁。白种人和非裔美国人患者的发病率相似（47.4%）。本研究中仅有1例亚洲患者（5.3%）。所有患者均表现为甲板色素沉着。诊断前的平均持续时间为33个月。共有63.2%的患者患有原位黑色素瘤，侵袭性病例的平均Breslow指数为2.18 mm。15例患者接受了保守手术，3例接受了指骨截肢术。所有患者均存活，4例患者进行了超过5年的随访。
原位病变表现为纵向条纹或全甲床黑甲，无甲营养不良。侵袭性病例表现为营养不良性病变（指甲纵向裂开）。保守手术是一个不错的选择，不会使预后恶化。所有皮肤科医生都应了解NAM的早期体征，因为预后取决于早期治疗。
