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Subungual Melanoma of the Hand

  • Melanoma
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The diagnosis of subungual melanoma (SUM) can be challenging and SUMs generally have a worse prognosis than melanomas arising elsewhere. Due to their rarity, the evidence to guide management is limited. This study sought to identify clinicopathological features predictive of outcome and to provide guidelines for management.

Methods

From a large, single-institution database, 103 patients with in situ (n = 9) or invasive (n = 94) SUMs of the hand treated between 1953 and 2014 were identified and their features analyzed.

Results

The most common site of hand SUMs was the thumb (53%). Median tumor thickness was 3.1 mm, and SUMs were commonly of the acral subtype (57%), ulcerated (58%), amelanotic (32%), and had mitoses (73%). Twenty-one patients reported prior trauma to the tumor site. Twenty-two patients were stage III at diagnosis; 7 underwent therapeutic lymph node dissection and 22 underwent elective lymph node dissection (5 positive), while 36 had sentinel node biopsy (SNB), 28% of which were positive. Forty percent of SNB-positive patients had involved non-sentinel nodes (SNs) in their completion lymph node dissection. Five-year melanoma-specific survival (MSS) and disease-free survival (DFS) rates were 70% and 52%, respectively. On multivariate analysis, regional node metastasis and right-hand tumor location were significant predictors of shorter DFS and MSS, whereas mitoses negatively impacted DFS only and increasing Breslow thickness impacted MSS only.

Conclusions

This study confirms that SUMs on the hand usually present at an advanced stage. Distal amputation appears safe for invasive SUMs, and SNB should be considered as these patients have a high risk of both SN and non-SN metastasis.

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Acknowledgment

The authors wish to thank The Dagmar Marshall Foundation and The Danish Cancer Society for financial research support for Annette Chakera to finalize this study. Assistance from colleagues at Melanoma Institute Australia and Royal Prince Alfred Hospital is also gratefully acknowledged. RAS is supported by an NHMRC Fellowship. JFT is supported by the Melanoma Foundation of the University of Sydney.

Author information

Author notes

  1. Annette H. Chakera and Michael J. Quinn have contributed equally to this work.

Authors and Affiliations

  1. Melanoma Institute Australia, Sydney, NSW, Australia

    Annette H. Chakera MD, Michael J. Quinn MBBS, Serigne Lo PhD, Martin Drummond MBiostat, Lauren E. Haydu PhD, Jeremy S. Bond MBChB, Jonathan R. Stretch MBBS, DPhil(Oxon), Robyn P. M. Saw MBMS, Ken J. Lee MBBS, W. H. McCarthy MBBS, Richard A. Scolyer MD & John F. Thompson MD

  2. Sydney Medical School, The University of Sydney, Sydney, NSW, Australia

    Serigne Lo PhD, Martin Drummond MBiostat, Lauren E. Haydu PhD, Jonathan R. Stretch MBBS, DPhil(Oxon), Robyn P. M. Saw MBMS, Ken J. Lee MBBS, W. H. McCarthy MBBS, Richard A. Scolyer MD & John F. Thompson MD

  3. Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia

    Jonathan R. Stretch MBBS, DPhil(Oxon), Robyn P. M. Saw MBMS, Ken J. Lee MBBS, W. H. McCarthy MBBS & John F. Thompson MD

  4. Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia

    Richard A. Scolyer MD

Authors
  1. Annette H. Chakera MD
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  2. Michael J. Quinn MBBS
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  3. Serigne Lo PhD
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  4. Martin Drummond MBiostat
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Corresponding author

Correspondence to John F. Thompson MD.

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Chakera, A.H., Quinn, M.J., Lo, S. et al. Subungual Melanoma of the Hand. Ann Surg Oncol 26, 1035–1043 (2019). https://doi.org/10.1245/s10434-018-07094-w

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  • DOI: https://doi.org/10.1245/s10434-018-07094-w

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