A comprehensive analysis of subungual melanomas in a tertiary center: Is amputation outmoded?

Aim: Subungual melanoma is a rare entity. The literature lacks information about its treatment. Alternative treatments exist; amputation or wide local excision (WLE), with or without sentinel lymph node biopsy (SLNB). This study discusses the classical approach for subungual melanoma and compares it with the alternatives. Materials and Methods: A retrospective analysis of subungual melanoma cases between 2008 and 2020 in a tertiary center was done. Results: Thirteen patients were found to have subungual melanoma. Amputation and SLNB were the treatment of choice in 12 patients with invasive diseases. In one patient with a in-situ illness, WLE and SLNB were applied. Mean Breslow thickness was found to be 4.2 mm. The preoperative evaluation showed no signs of metastases in 10 patients, and these patients had SLNB. Two patients had pathological lymph node characteristics in the preoperative evaluation and had elective lymph node dissection (ELND) without SLNB. The mean follow-up was six years, and seven patients died during the follow-ups. Six patients died of natural causes, while one died of systemic disease. Conclusion: Subungual melanoma is a disease that can be controlled with amputation. WLE can be used in in-situ melanomas, but amputation is still a good choice for invasive illnesses.