Treatment: Excision and amputation
Amputation or wide excision are the only accepted treatments for subungual melanoma. However, there is no clear consensus regarding the most appropriate type of excision, biopsy, or level of amputation.5 Limb perfusion chemotherapy is thought to increase survival in selected cases.
Outcomes
Subungual melanoma typically has a worse outcome than cutaneous melanoma, but the causes remain unclear. Anatomic location has often been cited as a prognostic marker, and many studies attribute the unusual location of subungual melanomas to their poorer prognosis.7
Some recent studies have found that worse outcomes are tied to the fact that subungual melanoma often presents at a much more advanced stage than cutaneous melanoma, while other studies have shown that even when controlled for diseased and stage, subungual melanoma typically has a worse prognosis than cutaneous melanoma.1 Racial differences in outcomes may also exist, as one study found that African Americans with subungual melanoma have a 3.5 times greater rate of death than Caucasians (95% confidence interval, 1.4–8.6). When rates were controlled for Clark and Wihm’s level, they continued to have a 2.6 times greater rate of death.2 This indicates that the greater mortality rate is not due entirely to either later stage of disease at presentation or to later diagnosis.
CORRESPONDENCE
Adam Leight, MD. E-mail: adamleight@satx.rr.com