Functional surgery delivers amputation-free benefit in nail unit melanoma

Patients who have nail unit melanoma (NUM) with a Breslow thickness (BT) of <0.8 mm may benefit from functional surgery, which offers an amputation-sparing advantage, suggests a recent study.

“However, NUM with risk factors for recurrence requires patient counselling and close follow-ups,” according to the investigators.

In this study, patients with NUM between 2008 and 2022 at a tertiary referral centre were reviewed retrospectively. The investigators generated multivariable Cox regression models, adjusted for male sex and BT. They also conducted a receiver operating characteristic analysis to determine the optimal cutoff points of the BT for stratifying the risk of recurrence.

A total of 140 NUM patients were evaluated, of which 33 had amputation and 107 functional surgery. The mean BT values were 3.14 and 0.70 mm in the amputation and surgery groups, respectively.

Recurrence occurred in 10 (30.30 percent) patients with amputation and 23 (21.5 percent) patients with functional surgery, while distant disease occurred in 10 (30.30 percent) and eight (7.48 percent), respectively. Factors associated with a higher risk for recurrence of distant disease were male sex, greater BT, amelanotic colour, ulcers, and nodules.

The optimal cutoff for stratifying recurrence risk following surgery was a BT of 0.8 mm (odds ratio, 5.32, 95 percent confidence interval, 2.04‒13.85).

“Minimally invasive NUM can be treated with functional surgery instead of amputation,” the investigators said.

The study was limited by its small sample.