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Conservative vs Aggressive Treatment of Minimally Invasive Nail Melanoma

By: Celeste L. Dixon
Posted: Monday, August 26, 2019

Functional surgery, a conservative treatment that involves full removal of a toenail or fingernail but does not involve amputation, resulted in no greater odds of recurrence of in situ or minimally invasive (Breslow thickness ≤ 0.5 mm) nail melanoma compared with more aggressive treatment, according to a literature meta-analysis published in the Journal of the American Academy of Dermatology. Previous evidence comparing the outcomes with amputation versus the less drastic option had been limited, and the ideal surgical method for nail melanoma has been debated for many years.

Corresponding author Je-Ho Mun, MD, PhD, of Seoul National University College of Medicine in Seoul, Korea, and co-investigators found five relevant observational studies after undertaking a thorough literature search. Each included at least five patients with in situ or minimally invasive nail melanoma. 

The odds ratio of recurrence synthesized from those 5 studies, which included 109 patients (88 functional operations and 21 amputations), was 1.57 (95% confidence interval, 0.31–8.00), reported Dr. Mun and colleagues. Although the small sample size was a potential limitation of their findings, there was “no difference” in recurrence between the two treatments, nor did the researchers uncover any metastasis or mortality due to these nail melanoma cases. “Considering the functional deficit after amputation, conservative surgery should be the treatment of choice [in this patient population],” the team concluded. “This study provides meaningful information for physicians who treat patients with melanoma.”

Disclosure: The study authors reported no conflicts of interest.



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