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J Plast Reconstr Aesthet Surg. 2007;60(6):635-8. Epub 2007 Feb 1.

Thumb subungual melanoma: is amputation necessary?

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Department of Plastic and Reconstructive Surgery, University Hospital of North Staffordshire, Stoke City Hospital, Stoke-on-Trent, UK.


Subungual melanoma is uncommon. Traditional teaching advocates amputation of the affected digit. Recent studies have shown that more distal levels of amputations do not compromise survival or recurrence rates. When the thumb is involved, functional and aesthetic loss can be substantial. We present a new conservative, digit-sparing approach in the treatment of subungual melanoma of the thumb. Four informed patients were recruited to undergo the new treatment. Local excision with 1cm margins down to and including the periosteum was carried out. Reconstruction was with a local flap. There has been one recurrence and no deaths with a minimum of 6 years follow up. In selected cases, conservative management of subungual melanoma allows preservation of length and minimises disability.

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