Photo Credit: Rytis Bernotas

The following is a summary of “Nail Unit Melanoma Treated with Mohs Micrographic Surgery: Technique, Local Recurrence Rate, and Surgical Outcomes,” published in the January 2025 issue of Dermatology by Morales et al. 

Digit-sparing Mohs micrographic surgery (MMS) is increasingly used for nail unit melanoma (NUM), though few case series have been published.  

Researchers conducted a retrospective study to examine the surgical technique, local recurrence rates, and reconstruction methods for NUM treated with MMS surgery using Melanoma antigen recognized by T cells-1 (MART-1) immunostaining.  

They analyzed biopsy-confirmed NUM cases treated with MMS using MART-1 immunostaining, identified from a prospectively maintained database (2008-2023). The primary outcome assessed was the rate of local recurrence and secondary outcomes included the frequency of subclinical spread and the proportions of cases undergoing ablative vs reconstructive amputation.  

The results showed 69 cases of NUM, including 51 melanomas in situ (73.9%) and 18 invasive melanomas (26.1%) with a mean Breslow thickness of 1.07 mm (range 0.2–5.4 mm). Local recurrence occurred in 1 case (1/69, 1.4%) during a mean follow-up of 38.2 months. Subclinical spread requiring more than 1 Mohs stage was observed in 38 cases (38/69, 55.1%). Amputation to achieve clear margins was needed in 5 cases (5/69, 7.2%), while reconstruction with amputation at various levels was performed in 33 cases (33/69, 47.8%) due to extensive exposed bone.  

Investigators concluded that MMS was effectively treated with low local recurrence rates, and while amputation was rarely required for clear margins, reconstruction might be necessary for extensive bone exposure. 

Source: jaad.org/article/S0190-9622(25)00102-1/abstract