AI Article Synopsis
- Minimally invasive nail unit melanoma (NUM) can be treated with functional surgery (FS) rather than amputation, which benefits patients by sparing limbs.
- A study of 140 NUM cases revealed that factors like male sex, greater Breslow thickness (BT), and tumor characteristics (such as amelanotic color) were linked to a higher risk of recurrence and distant disease.
- The research suggested a BT cut-off of 0.8 mm for determining recurrence risk, indicating that FS is a viable option for patients with BT below this threshold, while those with higher risks need careful monitoring and discussion with their healthcare provider.
Article Abstract
Background: Minimally invasive nail unit melanoma (NUM) can be treated with functional surgery (FS) instead of amputation.
Objective: To determine risk factors associated with recurrence in NUM.
Methods: We retrospectively reviewed patients with NUM between 2008 and 2022 at a tertiary referral center. Multivariable Cox regression models adjusted for male sex and Breslow thickness (BT) were generated. Receiver operating characteristic analysis was performed to determine optimal cut-off points of the BT for stratifying recurrence risk.
Results: We evaluated 140 NUM cases (33 amputation and 107 FS). The mean BT values were 3.14 ± 2.62 mm (amputation) and 0.70 ± 1.36 mm (FS). Recurrence occurred in 10 (30.30%) patients with amputation and 23 (21.5%) with FS. Distant disease occurred in 10 (30.30%) patients with amputation and 8 (7.48%) with FS. Male sex, greater BT, amelanotic color, ulcers, and nodules were associated with greater risk for recurrence or distant disease. A BT of 0.8 mm was deemed the optimal cut-off for stratifying recurrence risk after surgery (odds ratio, 5.32; 95% CI, 2.04-13.85).
Limitations: Small sample.
Conclusion: FS can be considered for NUM with a BT < 0.8 mm, providing an amputation-sparing benefit. However, NUM with risk factors for recurrence requires patient counselling and close follow-ups.
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| http://dx.doi.org/10.1016/j.jaad.2022.12.039 | DOI Listing |
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