[Translated article] Clinical and Histopathologic Features of Subungual Melanoma in 57 Mexican Patients: A 5-Year Cohort Study.

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.

Clinical and Histopathologic Features of Subungual Melanoma in 57 Mexican Patients: A 5-Year Cohort Study. / Características clínicas e histopatológicas de melanoma subungueal en 57 pacientes mexicanos: una cohorte de 5 años.

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.

Subungual melanoma: A retrospective cohort of 157 cases from Brazilian National Cancer Institute.

BACKGROUND: Subungual melanoma (SM) is rare. The lesions are thick at the time of diagnosis. Few studies have evaluated SM in Brazil. OBJECTIVE: The objective of this study was to investigate the factors associated with the survival of SM patients from the Brazilian National Cancer Institute. METHODS: One-hundred and fifty-seven patients diagnosed with SM were included in this study. We evaluated the epidemiologic, clinical, and histopathological data. Overall survival (OS) and relapse-free survival (RFS) curves were computed using the Kaplan-Meier method. Multivariable analyses were conducted using the Cox proportional hazard regression model. RESULTS: Among the 157 patients, 87 (55.4%) were female. The median age was 68 years old. Median tumor depth was 6.0 mm. Lesions were ulcerated in 94 (59.9%). OS and RFS rates for 5 years were 61.0% and 41.8%, respectively. Median follow-up time was 28 months. The factors associated with OS were Breslow thickness and ulceration, and for RFS, they were the anatomical site, Breslow thickness, and ulceration. CONCLUSION: This is the largest series of SM patients. The 5-year OS and RFS rates were low (61.0% and 48.2%, respectively), and the main prognostic factors for OS were Breslow thickness and ulceration.

Melanoma subungueal de la mano: reporte de un caso / Hand’s subungueal melanoma: A case report

El melanoma es considerado una neoplasia melanocítica maligna; la localización subungueal corresponde al 0.7-3.5% de todos los melanomas. Clínicamente se presenta como una melanoniquia en general asintomática. Comunicamos un paciente masculino de 67 años, que consulta por presentar melanoniquia estriada en el cuarto dedo de la mano izquierda. El estudio histopatológico de biopsia informa un melanoma acral, por lo que se procede a realizar resección completa de la lesión con amputación de la falange distal; el paciente evolucionó satisfactoriamente. Este melanoma se origina de la matriz ungular, aunque se ha propuesto la asociación con traumas, su etiología no está clara. Histológicamente, se caracteriza por una proliferación de melanocitos atípicos o fusiformes, con grados variables de invasión; algunas lesiones son pigmentadas y otras amelanóticas. Se debe establecer el diagnóstico diferencial con: hematomas, osteomielitis, onicomicosis, granuloma piógeno, paroniquia, enfermedad de Kaposi, carcinoma espinocelular, entre otras. Algunos factores pronósticos incluyen profundidad de invasión, índice mitótico, ulceración, índice de proliferación con Ki 67 para nombrar solo algunos factores del denominado “histopronóstico”. El retraso en el diagnóstico del melanoma subungueal condiciona un mal pronóstico. El tratamiento apunta hacia la intervención quirúrgica en estadios tempranos, con evaluación del ganglio centinela (esto varía según la escuela académica). Sin embargo, actualmente se hace referencia a nuevos fármacos, que modifican la respuesta inmune o que intervienen en el metabolismo celular, con lo que se dan los primeros pasos para modificar la historia natural de esta enfermedad.

Introduction: melanoma is considered a biologically aggressive neoplasm. It’s more common in the 6th decade. Subungual melanoma corresponding to 0.7-3.5% of all melanomas. The most common locations are hallux, thumb, index and ring. Clinically, it presents as an asymptomatic melanonychia. Case Report: male aged 67 who consulted for striated melanonychia fourth finger left hand. Biopsy histopathological study reports malignant melanoma. Complete resection of the lesion was performed with amputation of distal phalanx. Patient evolves satisfactorily. Discussion: this melanoma originates from the nail matrix. Although it has been proposed partnership with traumas, its etiology is unclear. Hasn’t been able to establish an association with race, skin type and sun exposure, as in other melanoma’s types. Histologically it is characterized by a proliferation of atypical melanocytes or fusiform with varying degrees of invasion. Some injuries are pigmented and others may be amelanotic. Should be established the differential diagnosis with hematomas, osteomyelitis, onychomycosis, pyogenic granuloma, paronychia, among other injuries. Some prognostic factors include depth of invasion, mitotic rat, ulceration, proliferation index among others. The delay in diagnosis of subungual melanoma determines a poor prognosis. The treatment aims to surgery in early stages, with evaluation of sentinel node. But now referred to new drugs that modify the immune response or that involve its cellular metabolism thus taking the first steps to modify the natural history of this disease.

Melanoma subungueal: desafío diagnóstico. A propósito de un caso / Subungual melanoma: diagnostic challenge. Report of a case

Objetivo: presentación de un caso clínico de melanoma subungueal de presentación atípica en el contexto de un paciente con antecedente traumático en mano izquierda y lesión nodular metastásica en región axilar izquierda. Métodos: se presenta caso de paciente masculino de 50 años de edad con antecedente de amputación de falange distal de pulgar izquierdo por traumatismo contuso y osteomielitis quien refiere inicio de enfermedad actual al presentar una lesión nodular en región axilar izquierda que aumenta progresivamente de volumen hasta 10 cm de diámetro, adherida a planos profundos con telangiectasias peritumorales y ruptura espontánea con salida de descarga fibrinosa no fétida, acompañada de dolor de moderada intensidad con limitación funcional del miembro superior ipsilateral, motivo por el cual consulta a centro hospitalario donde es ingresado. Resultados: se le realiza biopsia de la lesión, la cual reportó tumor maligno indiferenciado de patrón epitelioide asociado a resultado positivo para vimentina y S-100 que confirma el diagnóstico de melanoma por lo que se decide iniciar ciclos de radioterapia. Conclusión: un posible diagnóstico diferencial del melanoma subungueal podría ser un hematoma subungueal pero cuando hay signos radiológicos de destrucción ósea, hay que tomar en cuenta osteomielitis, osteolisis postraumática o metástasis de un tumor primario. En pacientes con melanoma subungueal, metástasis ganglionar y antecedente de traumatismo en el sitio del tumor primario, es importante sospechar esta patología, con el fin de mejorar la supervivencia mediante el diagnóstico precoz(AU)

Objective: presentation of clinical case of an atypical presentation of subungual melanoma in the context of a patient with a history of trauma in his left hand and nodular metastatic lesion in left axillary region. Methods: a case report of male patient aged 50 with a history of amputation of distal phalanx of the left hallux due to blunt trauma and osteomyelitis who reports onset of present illness by presenting a nodular lesion in the left axillary region with progressive volume increase up to 10 cm diameter, attached to deep planes with peritumoral telangiectasias and spontaneous rupture with fibrinous and not fetid discharge outlet, with moderate intensity pain and ipsilateral upper limb functional limitation, which is why the patient is admitted to the hospital. Results: the biopsy of the lesion reported a malignant undifferentiated tumor with epithelioid pattern associated with positive outcome for vimentin and S-100 confirming the diagnosis of melanoma so it was decided to start cycles of radiotherapy. Conclusion: a differential diagnosis of the subungual melanoma could be a subungual hematoma but when there is radiographic evidence of bone destruction, we must take into consideration osteomyelitis, posttraumatic osteolysis or metastases from a primary tumor. In patients with subungual melanoma, lymph node metastases and a history of trauma in the primary tumor site, this entity must be considered in order to improve survival through early diagnosis(AU)