{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T18:47:46Z","timestamp":1791917266832,"version":"4.3.4"},"reference-count":27,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2021,9,15]],"date-time":"2021-09-15T00:00:00Z","timestamp":1631664000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medical Sciences"],"abstract":"<jats:p>Despite the changing paradigms of melanoma treatment in recent years, there remains a relative paucity of data regarding subungual melanoma in the literature. From 2002\u20132018, 25 patients with subungual melanoma were surgically treated at our facility. A retrospective chart review was conducted to collect relevant demographic, clinical, pathologic, and outcomes data. The median age at diagnosis was 69 years. Most patients (60%) were male, and the melanoma lesion was most often located on the foot (68%). Acral-lentiginous was the most common histologic subtype (59%), and the median Breslow thickness was 3.4 mm. Fifteen patients (63%) underwent a sentinel lymph node biopsy as part of their surgical resection, and four of these patients (27%) had metastatic disease in the lymph nodes. In total, 10 patients underwent lymph node dissection of the involved basin. The median follow up was 21 months in this patient population. Age, gender, tumor location, ulceration, and lesion histology were not significantly associated with recurrence free survival (RFS). Increasing Breslow thickness was found to be significantly associated with shorter RFS (HR: 1.07, CI: 1.03\u20131.55). In total, 13 patients developed a disease recurrence, and RFS rates were 66% at 1 year and 40% at 3 years. Additionally, 91 and 37% of patients were alive at one year and three years, respectively. Subungual melanomas are rare lesions that often have a more advanced stage at diagnosis, which contributes to the poor prognosis of these cutaneous malignancies.<\/jats:p>","DOI":"10.3390\/medsci9030057","type":"journal-article","created":{"date-parts":[[2021,9,15]],"date-time":"2021-09-15T21:47:11Z","timestamp":1631742431000},"page":"57","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Subungual Melanoma: A Single Institution Experience"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9808-1405","authenticated-orcid":false,"given":"Christopher J.","family":"LaRocca","sequence":"first","affiliation":[{"name":"Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lily","family":"Lai","sequence":"additional","affiliation":[{"name":"City of Hope National Medical Center, Department of Surgery, Duarte, CA 91010, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca A.","family":"Nelson","sequence":"additional","affiliation":[{"name":"City of Hope National Medical Center, Department of Computational and Quantitative Medicine, Duarte, CA 91010, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Badri","family":"Modi","sequence":"additional","affiliation":[{"name":"City of Hope National Medical Center, Department of Surgery, Duarte, CA 91010, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brooke","family":"Crawford","sequence":"additional","affiliation":[{"name":"UCLA Medical Center, Department of Orthopedic Surgery, Santa Monica, CA 90404, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,9,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1056\/NEJMoa1504030","article-title":"Combined Nivolumab and Ipilimumab or Monotherapy in Untreated Melanoma","volume":"373","author":"Larkin","year":"2015","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1038\/nrclinonc.2017.43","article-title":"Targeted agents and immunotherapies: Optimizing outcomes in melanoma","volume":"14","author":"Luke","year":"2017","journal-title":"Nat. Rev. Clin. Oncol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2780","DOI":"10.1200\/JCO.2014.58.3377","article-title":"Talimogene Laherparepvec Improves Durable Response Rate in Patients With Advanced Melanoma","volume":"33","author":"Andtbacka","year":"2015","journal-title":"J. Clin. Oncol"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2211","DOI":"10.1056\/NEJMoa1613210","article-title":"Completion Dissection or Observation for Sentinel-Node Metastasis in Melanoma","volume":"376","author":"Faries","year":"2017","journal-title":"N. Engl. J. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1097\/PRS.0000000000000529","article-title":"Subungual melanoma: A review of current treatment","volume":"134","author":"Cochran","year":"2014","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1035","DOI":"10.1245\/s10434-018-07094-w","article-title":"Subungual Melanoma of the Hand","volume":"26","author":"Chakera","year":"2019","journal-title":"Ann. Surg. Oncol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1097\/SAP.0b013e3182a0df64","article-title":"Surgical management of subungual melanoma: Mayo clinic experience of 124 cases","volume":"71","author":"Nguyen","year":"2013","journal-title":"Ann. Plast. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1111\/j.1365-2133.1996.tb16218.x","article-title":"Epidemiology and prognosis of subungual melanoma in 34 Japanese patients","volume":"134","author":"Kato","year":"1996","journal-title":"Br. J. Dermatol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1159\/000441293","article-title":"The Prognosis of Nail Apparatus Melanoma: 20 Years of Experience from a Single Institute","volume":"232","author":"Dika","year":"2016","journal-title":"Dermatology"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1046\/j.1365-2133.1998.02365.x","article-title":"The incidence and prognosis of nail apparatus melanoma. A retrospective study of 105 patients in four English regions","volume":"139","author":"Banfield","year":"1998","journal-title":"Br. J. Dermatol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1038\/nature22071","article-title":"Whole-genome landscapes of major melanoma subtypes","volume":"545","author":"Hayward","year":"2017","journal-title":"Nature"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Elefanti, L., Zamuner, C., Del Fiore, P., Stagni, C., Pellegrini, S., Dall\u2019Olmo, L., Fabozzi, A., Senetta, R., Ribero, S., and Salmaso, R. (2021). The Molecular Landscape of Primary Acral Melanoma: A Multicenter Study of the Italian Melanoma Intergroup (IMI). Int. J. Mol. Sci., 22.","DOI":"10.3390\/ijms22083826"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1159\/000063354","article-title":"Is subungual melanoma related to trauma?","volume":"204","author":"Mohrle","year":"2002","journal-title":"Dermatology"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1111\/ajd.12145","article-title":"Tanning bed and nail lamp use and the risk of cutaneous malignancy: A review of the literature","volume":"55","author":"Tait","year":"2014","journal-title":"Australas. J. Dermatol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1016\/S0190-9622(00)90137-3","article-title":"The ABC rule for clinical detection of subungual melanoma","volume":"42","author":"Levit","year":"2000","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1136\/bmj.1.5903.310","article-title":"Subungual malignant melanoma: Difficulty in diagnosis","volume":"1","author":"Leppard","year":"1974","journal-title":"Br. Med. J."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2074","DOI":"10.1002\/1097-0142(19801101)46:9<2074::AID-CNCR2820460928>3.0.CO;2-K","article-title":"Subungual malignant melanoma: A clinical-pathologic study","volume":"46","author":"Patterson","year":"1980","journal-title":"Cancer"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1097\/00000658-199402000-00012","article-title":"Surgical management and prognostic factors in patients with subungual melanoma","volume":"219","author":"Heaton","year":"1994","journal-title":"Ann. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Shaikh, W.R., Dusza, S.W., Weinstock, M.A., Oliveria, S.A., Geller, A.C., and Halpern, A.C. (2016). Melanoma Thickness and Survival Trends in the United States, 1989 to 2009. J. Natl. Cancer. Inst., 108.","DOI":"10.1093\/jnci\/djv294"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"8065","DOI":"10.1200\/JCO.2005.02.4976","article-title":"A population-based validation of the American Joint Committee on Cancer melanoma staging system","volume":"23","author":"Gimotty","year":"2005","journal-title":"J. Clin. Oncol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"3618","DOI":"10.1245\/s10434-013-3089-0","article-title":"Prognosis of acral melanoma: A series of 281 patients","volume":"20","author":"Bello","year":"2013","journal-title":"Ann. Surg. Oncol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1746","DOI":"10.1016\/j.bjps.2017.08.001","article-title":"Subungual melanoma: Management in the modern era","volume":"70","author":"Reilly","year":"2017","journal-title":"J. Plast. Reconstr. Aesthet. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1902","DOI":"10.1097\/PAS.0b013e318073c600","article-title":"Subungual melanoma: A study of 124 cases highlighting features of early lesions, potential pitfalls in diagnosis, and guidelines for histologic reporting","volume":"31","author":"Tan","year":"2007","journal-title":"Am. J. Surg. Pathol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1307","DOI":"10.1056\/NEJMoa060992","article-title":"Sentinel-node biopsy or nodal observation in melanoma","volume":"355","author":"Morton","year":"2006","journal-title":"N. Engl. J. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1142","DOI":"10.1002\/jso.25242","article-title":"Subungual melanoma: A retrospective cohort of 157 cases from Brazilian National Cancer Institute","volume":"118","author":"Nunes","year":"2018","journal-title":"J. Surg. Oncol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"852","DOI":"10.1111\/j.1365-2133.2011.10477.x","article-title":"Conservative surgical management of subungual (matrix derived) melanoma: Report of seven cases and literature review","volume":"165","author":"Sureda","year":"2011","journal-title":"Br. J. Dermatol."},{"key":"ref_27","first-page":"366","article-title":"\u201cFunctional\u201d surgery in subungual melanoma","volume":"29","author":"Moehrle","year":"2003","journal-title":"Dermatol. Surg."}],"container-title":["Medical Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3271\/9\/3\/57\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:00:06Z","timestamp":1760166006000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3271\/9\/3\/57"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,15]]},"references-count":27,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2021,9]]}},"alternative-id":["medsci9030057"],"URL":"https:\/\/doi.org\/10.3390\/medsci9030057","relation":{},"ISSN":["2076-3271"],"issn-type":[{"value":"2076-3271","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,15]]}}}