The following is a summary of “Risk of recurrence of nail unit melanoma after functional surgery versus amputation,” published in the January 2023 issue of Dermatology by Oh, et al.

For a study, researchers aimed to identify the risk factors associated with recurrence in minimally invasive nail unit melanoma (NUM) and to determine the optimal cut-off point of Breslow thickness (BT) for stratifying recurrence risk after functional surgery (FS).

The medical records of 140 patients with NUM, treated between 2008 and 2022 at a tertiary referral center, were reviewed. Of these, 33 underwent amputation, and 107 underwent FS. Multivariable Cox regression models were generated and adjusted for the male sex and BT. In addition, receiver operating characteristic analysis was performed to identify the optimal cut-off point of BT for stratifying the risk of recurrence.

They looked at 140 NUM cases (107 FS and 33 amputations). About 3.14±2.62 mm (amputation) and 0.70±1.36 mm (FS) were the mean BT values. 10 patients (30.30%) who had undergone amputations and 23 (21.5%) who had FS experienced recurrence. In 10 (30.30%) patients with amputations and 8 (7.48%) patients with FS, distant disease was present. Greater risk for the distant or recurrent disease was linked to the male sex, higher BT, amelanotic color, ulceration, and nodules. The best cut-off for recurrence risk stratification following surgery was determined to be a BT of 0.8 mm (odds ratio, 5.32; 95% CI, 2.04-13.85).

Functional surgery can be considered an amputation-sparing treatment for NUM with a BT < 0.8 mm. However, patients with risk factors for recurrence require close follow-up and counseling.

Reference: jaad.org/article/S0190-9622(23)00063-4/fulltext