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Silva García GA, Sánchez Cárdenas CD, Mendoza Ibarra T, Pérez Martínez CA, Guevara Castillo RM, Pulido Díaz N. Clinical and Histopathologic Features of Subungual Melanoma in 57 Mexican Patients: A 5-Year Cohort Study. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:293-297. [PMID: 37871891 DOI: 10.1016/j.ad.2023.05.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/04/2023] [Accepted: 05/12/2023] [Indexed: 10/25/2023] Open
Abstract
Although subungual melanoma is uncommon, it is associated with worse outcomes than melanomas in other locations and accounts for 1% to 23% of all melanomas, depending on the population. The aim of this study was to describe the clinical and histopathologic features of subungual melanoma in a Mexican population. We identified 303 patients with melanoma, and of these, 19% (57 patients with a median age of 71 years) had subungual melanoma. The main sites affected were the lower limbs (52.6%) and the toe (75.4%). The most common histologic subtype was acral lentiginous melanoma (50.9%). Median Breslow thickness was 3 mm, and stage IA tumors were the most common (in 28.1% of patients). Recurrence and metastasis occurred in 19.3% and 8.8% of patients, respectively. The clinical and histopathologic features identified are similar to those described in the literature. Early diagnosis and treatment are crucial for improving prognosis.
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Affiliation(s)
- G A Silva García
- Servicio de Dermatología, Centro Médico Nacional «La Raza», Ciudad de México, México
| | - C D Sánchez Cárdenas
- Servicio de Dermatología, Centro Médico Nacional «La Raza», Ciudad de México, México.
| | - T Mendoza Ibarra
- Servicio de Dermatología, Centro Médico Nacional «La Raza», Ciudad de México, México
| | - C A Pérez Martínez
- Departamento de Medicina Interna, Hospital General «Ajusco Medio», Secretaría de Salud de México, Estado de México, México
| | - R M Guevara Castillo
- Servicio de Dermatología, Centro Médico Nacional «La Raza», Ciudad de México, México
| | - N Pulido Díaz
- Servicio de Dermatología, Centro Médico Nacional «La Raza», Ciudad de México, México
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Silva García GA, Sánchez Cárdenas CD, Mendoza Ibarra T, Pérez Martínez CA, Guevara Castillo RM, Pulido Díaz N. [Translated article] Clinical and Histopathologic Features of Subungual Melanoma in 57 Mexican Patients: A 5-Year Cohort Study. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:T293-T297. [PMID: 38242433 DOI: 10.1016/j.ad.2024.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/12/2023] [Indexed: 01/21/2024] Open
Abstract
Although subungual melanoma is uncommon, it is associated with worse outcomes than melanomas in other locations and accounts for 1% to 23% of all melanomas, depending on the population. The aim of this study was to describe the clinical and histopathologic features of subungual melanoma in a Mexican population. We identified 303 patients with melanoma, and of these, 19% (57 patients with a median age of 71 years) had subungual melanoma. The main sites affected were the lower limbs (52.6%) and the toe (75.4%). The most common histologic subtype was acral lentiginous melanoma (50.9%). Median Breslow thickness was 3 mm, and stage IA tumors were the most common (in 28.1% of patients). Recurrence and metastasis occurred in 19.3% and 8.8% of patients, respectively. The clinical and histopathologic features identified are similar to those described in the literature. Early diagnosis and treatment are crucial for improving prognosis.
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Affiliation(s)
- G A Silva García
- Servicio de Dermatología, Centro Médico Nacional «La Raza», Ciudad de México, Mexico
| | - C D Sánchez Cárdenas
- Servicio de Dermatología, Centro Médico Nacional «La Raza», Ciudad de México, Mexico.
| | - T Mendoza Ibarra
- Servicio de Dermatología, Centro Médico Nacional «La Raza», Ciudad de México, Mexico
| | - C A Pérez Martínez
- Departamento de Medicina Interna, Hospital General «Ajusco Medio», Secretaría de Salud de México, Estado de México, Mexico
| | - R M Guevara Castillo
- Servicio de Dermatología, Centro Médico Nacional «La Raza», Ciudad de México, Mexico
| | - N Pulido Díaz
- Servicio de Dermatología, Centro Médico Nacional «La Raza», Ciudad de México, Mexico
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Tsiogka A, Rubin AI, Gregoriou S, Soulaidopoulos S, Belyayeva H, Rigopoulos D. Prevalence of subungual melanoma in patients with cutaneous malignant melanoma: A systematic review and meta-analysis. J Eur Acad Dermatol Venereol 2024; 38:77-83. [PMID: 37644688 DOI: 10.1111/jdv.19482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 08/09/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Subungual melanoma (SUM) is a rare type of cutaneous malignant melanoma (CMM) associated with poor prognosis, while data regarding its prevalence are scarce. OBJECTIVES We sought to provide a comprehensive systematic review and meta-analysis of the prevalence rates of SUM among all types of CMM, considering certain demographic and clinical characteristics. METHODS The MEDLINE electronic database was searched systematically to identify eligible studies providing prevalence rate estimates of SUM in patients with CMM. Included studies were further analysed to estimate the relative prevalences of SUM according to study design, study years, geographical region and sex distribution. RESULTS Twenty-eight studies met the inclusion criteria. The overall SUM prevalence was 1.9% (95% CI [1.5%-2.3%]). The prevalence of SUM did not differ significantly between population- and hospital-based studies and remained stable over time. However, it was found to be significantly higher in Asians compared to patients of other geographical regions as well as in studies with more men than women compared to those with female preponderance (p < 0.001). CONCLUSIONS In all, the overall SUM prevalence among all subtypes of CMM was estimated at 1.9%, without significant changes over time, and was found to exhibit significant variability between subgroups of different geographical regions.
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Affiliation(s)
- Aikaterini Tsiogka
- Faculty of Medicine, First Department of Dermatology-Venereology, Andreas Sygros Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Adam I Rubin
- Department of Dermatology, Perelman School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Stamatios Gregoriou
- Faculty of Medicine, First Department of Dermatology-Venereology, Andreas Sygros Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Stergios Soulaidopoulos
- First Department of Cardiology, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Helena Belyayeva
- Faculty of Medicine, First Department of Dermatology-Venereology, Andreas Sygros Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitris Rigopoulos
- Faculty of Medicine, First Department of Dermatology-Venereology, Andreas Sygros Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Kudsi MA, Kudsi MS, Ghazy A, Alyousfi R, Khouja MN, Etr A. Unusual location of subungual melanoma surgically managed successfully: A rare case report from Syria. Int J Surg Case Rep 2023; 113:109062. [PMID: 37980775 PMCID: PMC10694301 DOI: 10.1016/j.ijscr.2023.109062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/08/2023] [Accepted: 11/11/2023] [Indexed: 11/21/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Acral lentiginous melanoma (ALM), the least common subtype of cutaneous melanoma, poses challenges in early detection, resulting in low survival rates. Subungual melanoma (SUM), a rare form of ALM originating from the nail matrix, is less common on the hands than on the feet, accounting in the hands for only 0.3 % of all cutaneous melanomas. This makes the case of hand subungual melanoma that we are presenting very rare and significant. CASE PRESENTATION A 64-year-old woman presented with an asymptomatic subungual lesion on her left fifth finger. The lesion, ranging in color from brown to black, did not cause bleeding and exhibited a clear nail plate rupture. An incisional biopsy confirmed the diagnosis of subungual melanoma. The patient underwent a proximal interphalangeal (PIP) joint amputation and remains in good health. Regular CT scans and clinical examination have shown no recurrence. CLINICAL DISCUSSION Subungual melanoma, a rare subtype of acral lentiginous melanoma, comprises less than 1 % of all melanomas. While the Hallux and thumb are commonly affected, our case involved the little finger which is the rarest site of hand subungual melanoma. Occurrence ages are between 50 and 70. The Hutchinson sign, nail fold pigmentation, indicates poor prognosis in advanced stages, which was positive in our case. Recommended management is amputation at the level of the most distal unaffected joint. CONCLUSION Our aim is to raise healthcare professionals' awareness of early recognition and management of subungual melanoma. Early detection and treatment reduce metastasis risk and improve survival rates.
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Affiliation(s)
| | - Mohammed Sami Kudsi
- Department of General Surgery, Aleppo University Hospital, Aleppo University, Aleppo, Syria
| | - Ayesha Ghazy
- Faculty of Medicine, Aleppo University, Aleppo, Syria
| | - Rama Alyousfi
- Department of Pathology, Aleppo University Hospital, Aleppo University, Aleppo, Syria
| | - M Noor Khouja
- Department of Plastic Surgery, Aleppo University Hospital, Aleppo University, Aleppo, Syria
| | - Aladdin Etr
- Department of Plastic Surgery, Aleppo University Hospital, Aleppo University, Aleppo, Syria
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Le M, Gabrielli S, Zloty D. Mohs Micrographic Surgery Is Equivalent to Nail Unit Excision or Amputation for Melanoma In Situ of the Nail Unit: A Systematic Review and Meta-Analysis. Dermatol Surg 2023; 49:755-758. [PMID: 37249515 DOI: 10.1097/dss.0000000000003840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Local recurrence (LR) rates of melanoma in situ (MIS) of the nail apparatus treated with different surgical modalities are unknown. OBJECTIVE To evaluate the differences in LR rates of nail apparatus MIS treated with Mohs micrographic surgery (MMS) versus nail unit excision (NUE) versus amputation. METHODS Studies of nail/subungual MIS treated with MMS, NUE, or amputation were identified through multiple literature databases, including PubMed, MEDLINE, Embase, Web of Science, and Cochrane Library. Pooled data were assessed through meta-analyses and Fisher exact test. RESULTS Of 280 studies identified, 20 met inclusion criteria (7 comparative studies and 13 single-arm studies). Among the 7 comparative studies, the LR was 4.38% (5/114) after NUE and 2.94% (1/34) after amputation (odds ratio: 0.937; 95% CI: 0.237-3.703). In the 13 noncomparative studies, 23 patients underwent MMS (pooled LR estimate: 11.07%; 95% CI: 3.22%-31.81%) and 140 patients underwent NUE (pooled LR estimate:8.04%, 95% CI: 4.43%-14.16%). The difference in LR rate between MMS, NUE, and amputation was not statistically significant ( p = .578). CONCLUSION Local recurrence of nail/subungual MIS in cases treated with MMS was not statistically different than in cases treated with NUE and was comparable to amputation. Further studies investigating the use of MMS for the treatment of nail/subungual MIS are warranted.
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Affiliation(s)
- Michelle Le
- Division of Dermatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Sofianne Gabrielli
- Division of Dermatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - David Zloty
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada
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Arasu A, Howard A, Tan CG, Prakash S, Kern JS. Clinical and dermoscopic features of nail unit melanoma in an Australian nail clinic cohort. Australas J Dermatol 2023; 64:417-422. [PMID: 37102442 DOI: 10.1111/ajd.14057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/02/2023] [Indexed: 04/28/2023]
Abstract
Nail unit melanoma carries diagnostic challenges conferring with its poor prognosis. This audit aims to characterise both clinical and dermoscopic features of nail unit malignant lesions and compare them with biopsied benign lesions. It focuses on informing future practice by aiding in the stratification and recognition of malignant diagnostic patterns in the Australian context.
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Affiliation(s)
- Alexis Arasu
- Department of Dermatology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Anne Howard
- Department of Dermatology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
- Skin Health Institute, Carlton, Victoria, Australia
| | - Chin-Guan Tan
- Melbourne Pathology (Sonic Healthcare), Collingwood, Victoria, Australia
| | - Saurabh Prakash
- Melbourne Pathology (Sonic Healthcare), Collingwood, Victoria, Australia
| | - Johannes S Kern
- Department of Dermatology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
- Skin Health Institute, Carlton, Victoria, Australia
- Faculty of Medicine, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Dermatology, Alfred Health, Melbourne, Victoria, Australia
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Greco P, Pham F, Duru G, Lainé X, Dalle S, Thomas L. Evaluation of the Knowledge of Primary Care Physicians About Important Nail Diseases Before and After a Short Online Training. Dermatol Pract Concept 2023; 13:e2023170. [PMID: 37557138 PMCID: PMC10412044 DOI: 10.5826/dpc.1303a170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2023] [Indexed: 08/11/2023] Open
Abstract
INTRODUCTION Nail diseases are often diagnosed late with a potential prognostic and functional impact. This could be partly due to knowledge gaps among primary care physicians (PCPs). OBJECTIVES To evaluate the knowledge about diagnosis and management of ten common/important nail conditions in a population of French PCPs and its improvement after a 31-minute online training session. METHODS We submitted 10 pre-test and post-test clinical cases and an educative online course on the diagnosis and the management of nail diseases to 138 volunteer PCPs; 73 completed the whole training path. RESULTS Compared to pre-test, more PCPs in the post-test required an urgent second opinion to dermatologist for pigmented melanoma (100% versus 80.3%; P <0.05) and use of inappropriate/dangerous systemic treatment for trauma-induced nail changes was reduced after the training program (0% versus 6.8%; P <0.05). A lack of knowledge remained after training for amelanotic melanoma with an increase of mycological/bacteriological tests (9.6% versus 0%; P <0.05). CONCLUSIONS Management of nail diseases by our panel of PCPs was suboptimal and was improved after a short online training.
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Affiliation(s)
- Pauline Greco
- Dermatology department, Hôpital Lyon Sud, Hospices Civils de Lyon, Lyons, France
- Claude Bernard Lyon-1 University, Lyon, France
| | - Félix Pham
- Dermatology department, Hôpital Lyon Sud, Hospices Civils de Lyon, Lyons, France
- Claude Bernard Lyon-1 University, Lyon, France
| | - Gérard Duru
- Claude Bernard Lyon-1 University, Lyon, France
| | | | - Stéphane Dalle
- Dermatology department, Hôpital Lyon Sud, Hospices Civils de Lyon, Lyons, France
- Claude Bernard Lyon-1 University, Lyon, France
- Cancer Research Center of Lyon, Lyons, France
| | - Luc Thomas
- Dermatology department, Hôpital Lyon Sud, Hospices Civils de Lyon, Lyons, France
- Claude Bernard Lyon-1 University, Lyon, France
- Cancer Research Center of Lyon, Lyons, France
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Anthony T, Goodman A, Fan J, Gnass RD, Sherman CL, Thomson B. A Rare Disease Presentation of Malignant Fungating Acral Melanoma of the Hand. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2023; 5:386-390. [PMID: 37323976 PMCID: PMC10264841 DOI: 10.1016/j.jhsg.2023.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 01/29/2023] [Indexed: 06/17/2023] Open
Abstract
Malignant melanoma is relatively uncommon and accounts for 1%-3% of all malignant tumors. Malignant melanoma of the hand is exceptionally rare and highly malignant, with rapid progression if left untreated. Early clinical symptoms can be overlooked, and the tumor is often at a late stage when patients seek care, prompting amputation of the affected region. We present a case of a 48-year-old man who presented with a rapidly progressive, large, fungating mass of the distal aspect of the little finger diagnosed as malignant melanoma. We describe the presentation and treatment of this patient, who ultimately underwent partial amputation of the fifth metacarpal. Histologic analysis demonstrated nodular melanoma.
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Affiliation(s)
- Taylor Anthony
- Department of Orthopaedic Surgery, Riverside University Health System, Moreno Valley, CA
| | - Aubree Goodman
- Department of Orthopaedic Surgery, Riverside University Health System, Moreno Valley, CA
| | - Juston Fan
- Department of Orthopaedic Surgery, Riverside University Health System, Moreno Valley, CA
| | - Ronaldo D. Gnass
- Department of Pathology, Riverside University Health System, Moreno Valley, CA
| | - Christopher L. Sherman
- Department of Orthopaedic Surgery, Riverside University Health System, Moreno Valley, CA
| | - Bryon Thomson
- Department of Radiology, Riverside University Health System, Moreno Valley, CA
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Conway J, Bellet JS, Rubin AI, Lipner SR. Adult and Pediatric Nail Unit Melanoma: Epidemiology, Diagnosis, and Treatment. Cells 2023; 12:cells12060964. [PMID: 36980308 PMCID: PMC10047828 DOI: 10.3390/cells12060964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/16/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
Nail unit melanoma (NUM) is an uncommon form of melanoma and is often diagnosed at later stages. Approximately two-thirds of NUMs are present clinically as longitudinal melanonychia, but longitudinal melanonychia has a broad differential diagnosis. Clinical examination and dermoscopy are valuable for identifying nail findings concerning malignancy, but a biopsy with histopathology is necessary to confirm a diagnosis of NUM. Surgical treatment options for NUM include en bloc excision, digit amputation, and Mohs micrographic surgery. Newer treatments for advanced NUM include targeted and immune systemic therapies. NUM in pediatric patients is extremely rare and diagnosis is challenging since both qualitative and quantitative parameters have only been studied in adults. There is currently no consensus on management in children; for less concerning melanonychia, some physicians recommend close follow-up. However, some dermatologists argue that the "wait and see" approach can cause delayed diagnosis. This article serves to enhance the familiarity of NUM by highlighting its etiology, clinical presentations, diagnosis, and treatment options in both adults and children.
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Affiliation(s)
- Jade Conway
- School of Medicine, New York Medical College, Valhalla, NY 10595, USA
| | - Jane S Bellet
- Department of Dermatology and Pediatrics, Duke University School of Medicine, Durham, NC 27710, USA
| | - Adam I Rubin
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
- Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
- Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Shari R Lipner
- Department of Dermatology, Weill Cornell Medicine, New York, NY 10021, USA
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Ito T, Hashimoto H, Kaku-Ito Y, Tanaka Y, Nakahara T. Nail Apparatus Melanoma: Current Management and Future Perspectives. J Clin Med 2023; 12:jcm12062203. [PMID: 36983205 PMCID: PMC10057171 DOI: 10.3390/jcm12062203] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 03/10/2023] [Accepted: 03/10/2023] [Indexed: 03/16/2023] Open
Abstract
Nail apparatus melanoma (NAM) is a rare type of cutaneous melanoma that belongs to the acral melanoma subtype. NAM is managed principally in accordance with the general treatment for cutaneous melanoma, but there is scarce evidence in support of this in the literature. Acral melanoma is genetically different from non-acral cutaneous melanoma, while recently accumulated data suggest that NAM also has a different genetic background from acral melanoma. In this review, we focus on recent advances in the management of NAM. Localized NAM should be surgically removed; amputation of the digit and digit-preserving surgery have been reported. Sentinel lymph node biopsy can be considered for invasive NAM for the purpose of accurate staging. However, it is yet to be clarified whether patients with metastatic sentinel lymph nodes can be safely spared completion lymph node dissection. Similar to cutaneous melanoma, immune checkpoint inhibitors and BRAF/MEK inhibitors are used as the first-line treatment for metastatic NAM, but data on the efficacy of these therapies remain scarce. The therapeutic effects of immune checkpoint inhibitors could be lower for NAM than for cutaneous melanoma. This review highlights the urgent need to accumulate data to better define the optimal management of this rare melanoma.
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Affiliation(s)
- Takamichi Ito
- Correspondence: ; Tel.: +81-92-642-5585; Fax: +81-92-642-5600
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Lin W, Ling F, Xiao L, Xiao C. Subungual Melanoma: A case report and literature review. Asian J Surg 2023:S1015-9584(23)00245-2. [PMID: 36878796 DOI: 10.1016/j.asjsur.2023.02.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 02/15/2023] [Indexed: 03/07/2023] Open
Affiliation(s)
- Wansheng Lin
- Department of Orthopedics, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital & Affiliated Hospital of the University of Electronic Science and Technology of China, Chengdu, 610072, China
| | - Fangqian Ling
- Xinjiang Medical University, Xinjiang, 830054, China
| | - Lin Xiao
- Department of Orthopedics, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital & Affiliated Hospital of the University of Electronic Science and Technology of China, Chengdu, 610072, China; School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610054, China
| | - Chengwei Xiao
- Department of Orthopedics, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital & Affiliated Hospital of the University of Electronic Science and Technology of China, Chengdu, 610072, China.
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Glavy JC, Peterson SL, Strain J, Byrd K, Flint JH. Metastatic Endometrioid Carcinoma Mimicking a Subungual Melanoma. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14494. [PMID: 36361369 PMCID: PMC9653594 DOI: 10.3390/ijerph192114494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/23/2022] [Accepted: 11/01/2022] [Indexed: 06/16/2023]
Abstract
CASE We report a case of a 76-year-old female with a stage IB, grade I endometrioid endometrial carcinoma who presented with right-hip pain and an enlarging black, exophytic, subungual lesion on her right-small-finger distal phalanx. Clinically, the distal phalanx lesion was suspicious for a subungual melanoma; however, advanced imaging suggested metastatic disease, with lesions in the acetabulum, lungs, brain, vulva, and vagina. CONCLUSION Partial amputation of the right, small finger and vulvar biopsies confirmed an endometrial carcinoma. To our knowledge, this is the first described case of endometrial adenocarcinoma metastasis to the phalanx of an upper extremity, mimicking a subungual melanoma.
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Affiliation(s)
- Jena C. Glavy
- Department of OBGYN, Navy Medicine Readiness and Training Command, San Diego, CA 92134, USA
| | - Shian L. Peterson
- Department of Orthopedic Surgery, Navy Medicine Readiness and Training Command, San Diego, CA 92134, USA
| | - Jonathan Strain
- Department of Pathology, Navy Medicine Readiness and Training Command, San Diego, CA 92134, USA
| | - Kevin Byrd
- Department of OBGYN, Navy Medicine Readiness and Training Command, San Diego, CA 92134, USA
| | - James H. Flint
- Department of Orthopedic Surgery, Navy Medicine Readiness and Training Command, San Diego, CA 92134, USA
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Das De S, Tan KB, Ho SAJE, Athanasian EA, Puhaindran ME. Pigmented Nail Lesions: When to Observe, When to Biopsy, When to Widely Excise, and When to Amputate? J Hand Surg Am 2022; 47:988-997. [PMID: 36050195 DOI: 10.1016/j.jhsa.2022.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 05/07/2022] [Accepted: 06/28/2022] [Indexed: 02/02/2023]
Abstract
Pigmented nail lesions are challenging problems. The differential diagnosis is broad and ranges from common self-limiting conditions, such as subungual hematoma and infection, to potentially fatal conditions, such as subungual melanoma. Clinical assessment and adjuncts, such as dermoscopy and imaging, are usually insufficient to establish a diagnosis, and a nail bed biopsy is often required. However, this is not an innocuous procedure and may result in permanent nail deformity. In addition, subjecting every patient with nail pigmentation to a biopsy will result in an unacceptably high rate of negative test results. Furthermore, histopathologic diagnosis of subungual melanoma remains challenging for several reasons. Once the diagnosis of subungual melanoma is established, the definitive treatment is controversial because the existing guidelines have largely been adapted from those for cutaneous melanoma. This review presents an approach to the diagnosis and management of pigmented subungual lesions and subungual melanoma, in particular, on the basis of the latest available evidence.
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Affiliation(s)
- Soumen Das De
- Department of Hand & Reconstructive Microsurgery, National University Hospital, Singapore, Singapore
| | - Kong Bing Tan
- Department of Pathology, National University Hospital, Singapore, Singapore
| | - Sue-Ann Ju Ee Ho
- Division of Dermatology, Department of Medicine, National University Hospital, Singapore, Singapore
| | | | - Mark E Puhaindran
- Department of Hand & Reconstructive Microsurgery, National University Hospital, Singapore, Singapore.
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A Woman With a Rapidly Expanding Subungual Mass: Subungual Endometrial Carcinoma Metastasis. Am J Dermatopathol 2022; 44:e103-e105. [PMID: 35642959 DOI: 10.1097/dad.0000000000002233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Darmawan CC, Ohn J, Mun J, Kim S, Lim Y, Jo SJ, Kim Y, Kim B, Seong M, Kim BJ, Lee C, Kwak Y, Chung HJ, Virós A, Lee D. Diagnosis and treatment of nail melanoma: A review of the clinicopathologic, dermoscopic, and genetic characteristics. J Eur Acad Dermatol Venereol 2022; 36:651-660. [DOI: 10.1111/jdv.17975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 12/20/2021] [Accepted: 01/07/2022] [Indexed: 12/01/2022]
Affiliation(s)
- C. C. Darmawan
- Department of Dermatology Seoul National University College of Medicine 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
- Institute of Human‐Environment Interface Biology Seoul National University 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
| | - J. Ohn
- Department of Dermatology Seoul National University College of Medicine 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
- Institute of Human‐Environment Interface Biology Seoul National University 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
| | - J.‐H. Mun
- Department of Dermatology Seoul National University College of Medicine 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
- Institute of Human‐Environment Interface Biology Seoul National University 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
- Department of Dermatology Seoul National University Hospital 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
- Skin Cancer/Chemotherapy Skin Care Center Seoul National University Cancer Hospital 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
| | - S. Kim
- Department of Dermatology Seoul National University Hospital 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
| | - Y. Lim
- Department of Dermatology Seoul National University Hospital 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
- Skin Cancer/Chemotherapy Skin Care Center Seoul National University Cancer Hospital 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
| | - S. J. Jo
- Department of Dermatology Seoul National University College of Medicine 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
- Institute of Human‐Environment Interface Biology Seoul National University 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
- Department of Dermatology Seoul National University Hospital 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
- Skin Cancer/Chemotherapy Skin Care Center Seoul National University Cancer Hospital 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
| | - Y.‐g. Kim
- Department of Laboratory Medicine Green Cross Genomic Laboratories 107 Ihyeonro 30beon‐gil Giheng‐gu Yongin‐Si Gyeonggi‐do 16924 Korea
| | - B. Kim
- Department of Laboratory Medicine Seoul National University College of Medicine 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
| | - M.‐W. Seong
- Department of Laboratory Medicine Seoul National University College of Medicine 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
| | - B. J. Kim
- Department of Plastic and Reconstructive Surgery Seoul National University College of Medicine 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
| | - C. Lee
- Department of Pathology Seoul National University College of Medicine 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
| | - Y. Kwak
- Department of Pathology Seoul National University College of Medicine 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
| | - H. J. Chung
- Department of Dermatology Harvard Medical School Boston Massachusetts 02215 USA
| | - A. Virós
- Skin Cancer and Ageing Lab Cancer Research UK Manchester Institute The University of Manchester Manchester SK10 4TG UK
| | - D.Y. Lee
- Department of Dermatology Samsung Medical Center Sungkyunkwan University 81 Irwon‐Ro, Gangnam‐gu Seoul 06351 Korea
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LaRocca CJ, Lai L, Nelson RA, Modi B, Crawford B. Subungual Melanoma: A Single Institution Experience. Med Sci (Basel) 2021; 9:medsci9030057. [PMID: 34564082 PMCID: PMC8482220 DOI: 10.3390/medsci9030057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/01/2021] [Accepted: 09/01/2021] [Indexed: 11/16/2022] Open
Abstract
Despite the changing paradigms of melanoma treatment in recent years, there remains a relative paucity of data regarding subungual melanoma in the literature. From 2002–2018, 25 patients with subungual melanoma were surgically treated at our facility. A retrospective chart review was conducted to collect relevant demographic, clinical, pathologic, and outcomes data. The median age at diagnosis was 69 years. Most patients (60%) were male, and the melanoma lesion was most often located on the foot (68%). Acral-lentiginous was the most common histologic subtype (59%), and the median Breslow thickness was 3.4 mm. Fifteen patients (63%) underwent a sentinel lymph node biopsy as part of their surgical resection, and four of these patients (27%) had metastatic disease in the lymph nodes. In total, 10 patients underwent lymph node dissection of the involved basin. The median follow up was 21 months in this patient population. Age, gender, tumor location, ulceration, and lesion histology were not significantly associated with recurrence free survival (RFS). Increasing Breslow thickness was found to be significantly associated with shorter RFS (HR: 1.07, CI: 1.03–1.55). In total, 13 patients developed a disease recurrence, and RFS rates were 66% at 1 year and 40% at 3 years. Additionally, 91 and 37% of patients were alive at one year and three years, respectively. Subungual melanomas are rare lesions that often have a more advanced stage at diagnosis, which contributes to the poor prognosis of these cutaneous malignancies.
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Affiliation(s)
- Christopher J. LaRocca
- Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA
- Correspondence: (C.J.L.); (B.C.); Tel.: +1-612-625-2991 (C.J.L.); +1-424-259-9823 (B.C.)
| | - Lily Lai
- City of Hope National Medical Center, Department of Surgery, Duarte, CA 91010, USA; (L.L.); (B.M.)
| | - Rebecca A. Nelson
- City of Hope National Medical Center, Department of Computational and Quantitative Medicine, Duarte, CA 91010, USA;
| | - Badri Modi
- City of Hope National Medical Center, Department of Surgery, Duarte, CA 91010, USA; (L.L.); (B.M.)
| | - Brooke Crawford
- UCLA Medical Center, Department of Orthopedic Surgery, Santa Monica, CA 90404, USA
- Correspondence: (C.J.L.); (B.C.); Tel.: +1-612-625-2991 (C.J.L.); +1-424-259-9823 (B.C.)
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17
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NAGORE E, MORO R. Surgical procedures in melanoma: recommended deep and lateral margins, indications for sentinel lymph node biopsy, and complete lymph node dissection. Ital J Dermatol Venerol 2021; 156:331-343. [DOI: 10.23736/s2784-8671.20.06776-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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18
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Seyed Jafari SM, Lieberherr S, Cazzaniga S, Beltraminelli H, Haneke E, Hunger RE. Melanoma of the Nail Apparatus: An Analysis of Patients' Survival and Associated Factors. Dermatology 2021; 238:156-160. [PMID: 33789262 DOI: 10.1159/000514493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 01/17/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND There are no proper management guidelines for nail apparatus melanoma (NAM). OBJECTIVE This study aimed to describe the clinical features, the presence of locoregional and distant metastases and disease-free and overall survival of NAM treated at our institution. METHODS A retrospective cohort review of patients with single, primary localized histopathologically confirmed NAM was performed. Collected data consisted of patients' characteristics and tumor features. In addition, local recurrence, locoregional metastases, distant metastases, disease-free survival (DFS) and overall survival (OS) were used as the main outcomes in our analysis. RESULTS Thirty patients with NAM were included. The overall survival (OS) in our patients at 5 and 10 years was 85.6 and 73.4%, respectively. DFS was significantly higher in patients with primary tumor location in the hand and without tumor-infiltrating lymphocytes (p value = 0.01 and 0.04, respectively). The patients with in situ melanoma or Breslow thickness <1 mm had a significantly higher chance of DFS and OS (90.0 and 94.1% at 5 years, respectively) than those with thicker NAM (58.3 and 55.6% at 5 years, respectively). A total of 53.3% of 30 patients underwent primary excision and covering with a full-thickness skin graft, while 13.3% of our 30 patients underwent digit amputation. The patients who underwent excision and covering with a full-thickness skin graft showed a complete overall survival (100% at 5 years). CONCLUSION Primary tumor location in the hand and lower tumor thickness might be correlated with better patients' survival. The study results suggest that total amputation might not be necessary in all NAM cases.
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Affiliation(s)
- S Morteza Seyed Jafari
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sven Lieberherr
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Simone Cazzaniga
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Centro Studi GISED, Bergamo, Italy
| | - Helmut Beltraminelli
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Eckart Haneke
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Centro de Dermatologia Epidermis, Instituto CUF, Porto, Portugal.,Dermatology Clinic Dermaticum, Freiburg, Germany
| | - Robert E Hunger
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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19
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Yim SH, Kwon IS, Hong D, Jung KE, Lee Y, Seo YJ, Choi CW. Predictor of Subungual Melanoma against Benign Longitudinal Melanonychia: A Retrospective Cohort Study from Korea. Ann Dermatol 2021; 33:147-153. [PMID: 33935456 PMCID: PMC8082004 DOI: 10.5021/ad.2021.33.2.147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 09/14/2020] [Accepted: 09/21/2020] [Indexed: 11/08/2022] Open
Abstract
Background Longitudinal melanonychia (LM) is a common clinical finding. Most cases of LM are benign, and a wait-and-see approach is preferred in the management of this condition. Nevertheless, it is important for clinicians to distinguish subungual melanoma (SUM) from other benign LMs. Objective To evaluate the demographic and clinicopathologic characteristics of LM in the Korean population and to identify the predictor of SUM against other benign conditions. Methods This was a single-center retrospective cohort study including patients who underwent nail biopsy for LM from January 2000 to May 2019. To identify the predictor of SUM, receiver operating characteristic (ROC) analyses was performed. Results A total of 68 cases of biopsy-proven LM were included in the analysis. Among the 68 cases, 8 were SUM. In univariable analysis, patients diagnosed with SUM were older (p=0.035) and had a longer disease duration (p=0.004). They also showed multicolor pigmentation of LM (p=0.022), a larger width of LM (p<0.001), and associated nail plate dystrophy (p=0.010) than patients diagnosed with benign conditions. In multivariable logistic regression, width of LM showed statistical significance (odds ratio, 1.083; 95% confidence interval, 1.018~1.153). ROC analysis suggested that an LM width >28% of the whole nail was the predictor of SUM (area under the curve=0.883; p<0.001). Conclusion SUM has distinct demographic and clinical features. The width of LM can predict SUM against other benign LMs.
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Affiliation(s)
- Su-Hyuk Yim
- Department of Dermatology, School of Medicine, Chungnam National University, Daejeon, Korea
| | - In Sun Kwon
- Clinical Trials Center, Chungnam National University Hospital, Daejeon, Korea
| | - Dongkyun Hong
- Department of Dermatology, School of Medicine, Chungnam National University, Daejeon, Korea
| | - Kyung Eun Jung
- Department of Dermatology, School of Medicine, Chungnam National University, Daejeon, Korea
| | - Young Lee
- Department of Dermatology, School of Medicine, Chungnam National University, Daejeon, Korea
| | - Young-Joon Seo
- Department of Dermatology, School of Medicine, Chungnam National University, Daejeon, Korea
| | - Chong Won Choi
- Department of Dermatology, School of Medicine, Chungnam National University, Daejeon, Korea
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20
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Abstract
Nail unit melanoma is an uncommon form of melanoma with worse prognosis compared with nonacral cutaneous melanoma. Nail unit melanoma is often diagnosed at a late stage. Clinical and dermoscopic features may suggest a diagnosis of nail unit melanoma, but confirmation requires histologic analysis. Like the clinical diagnosis, histopathologic diagnosis of nail unit melanoma is also difficult. The surgical management of nail unit melanoma has evolved from aggressive amputations to digit-sparing approaches. This article reviews the clinical presentation, diagnosis, and surgical treatment of nail unit melanoma to promote early diagnosis and rational surgery.
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21
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Abstract
Melanoma is an aggressive form of skin cancer associated with significant morbidity and mortality. Although commonly seen in dermatologist clinics, orthopaedic surgeons must be aware of these lesions in various ways. The five common musculoskeletal manifestations of melanoma will be discussed as well as the epidemiology, pathogenesis, diagnosis, staging, treatment, and prognosis of melanoma. With an index of suspicion and awareness of melanoma, a thorough history and detailed physical examination are critical in establishing a diagnosis. An adequately performed biopsy will confirm the diagnosis and assist in determining prognosis. As ambassadors of health for the musculoskeletal system, orthopaedic surgeons may be the first practitioners to encounter a pigmented skin lesion. Acral pigmented lesions should prompt a concern for melanoma with appropriate subsequent steps for management to follow. Finally, it is important for every orthopaedic surgeon to consider disseminated melanoma in the differential diagnosis of a skeletal metastasis, a deep soft-tissue mass, or lymphadenopathy in a patient with a previous history of a melanotic lesion.
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22
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Lieberherr S, Cazzaniga S, Haneke E, Hunger R, Seyed Jafari S. Melanoma of the nail apparatus: a systematic review and meta‐analysis of current challenges and prognosis. J Eur Acad Dermatol Venereol 2020; 34:967-976. [DOI: 10.1111/jdv.16121] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 11/21/2019] [Indexed: 01/03/2023]
Affiliation(s)
- S. Lieberherr
- Department of Dermatology Inselspital Bern University Hospital University of Bern Bern Switzerland
| | - S. Cazzaniga
- Department of Dermatology Inselspital Bern University Hospital University of Bern Bern Switzerland
- Centro Studi GISED Bergamo Italy
| | - E. Haneke
- Department of Dermatology Inselspital Bern University Hospital University of Bern Bern Switzerland
- Centro de Dermatologia Epidermis Instituto CUF Porto Portugal
- Dermatology Clinic Dermaticum Freiburg Germany
| | - R.E. Hunger
- Department of Dermatology Inselspital Bern University Hospital University of Bern Bern Switzerland
| | - S.M. Seyed Jafari
- Department of Dermatology Inselspital Bern University Hospital University of Bern Bern Switzerland
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23
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Wollina U, Tempel S, Hansel G. Subungual melanoma: A single center series from Dresden. Dermatol Ther 2019; 32:e13032. [DOI: 10.1111/dth.13032] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/01/2019] [Accepted: 07/20/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Uwe Wollina
- Department of Dermatology and AllergologyReconstructive Surgery, and Hand Surgery, Städtisches Klinikum Dresden, Academic Teaching Hospital Dresden Germany
| | - Sven Tempel
- Department of Trauma Surgery, Reconstructive Surgery, and Hand SurgeryStädtisches Klinikum Dresden, Academic Teaching Hospital Dresden Germany
| | - Gesina Hansel
- Department of Dermatology and AllergologyReconstructive Surgery, and Hand Surgery, Städtisches Klinikum Dresden, Academic Teaching Hospital Dresden Germany
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24
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Chakera AH, Thompson JF. ASO Author Reflections: Subungual Melanomas of the Hand Present Diagnostic and Therapeutic Challenges. Ann Surg Oncol 2019; 26:1044-1045. [PMID: 30719637 DOI: 10.1245/s10434-019-07196-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Indexed: 11/18/2022]
Affiliation(s)
| | - John F Thompson
- Melanoma Institute Australia, Sydney, NSW, Australia. .,Sydney Medical School, The University of Sydney, Sydney, NSW, Australia. .,Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
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