Tumor invasion in the hyponychium is associated with distant metastasis and poor prognosis in subungual melanoma: A histologic landscape of 44 cases - 08/07/21

Doi : 10.1016/j.jaad.2021.06.847

Hyokyung Yoo, MD ^a, Hyeonwoo Kim, MD ^b, Sung Tack Kwon, MD, PhD ^a, Seong Jin Jo, MD, PhD ^c, Je-Ho Mun, MD, PhD ^c, Cheol Lee, MD, PhD ^d, Yoonjin Kwak, MD, PhD ^d,^⁎ , Byung Jun Kim, MD ^a,^⁎
^a Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
^b View Plastic Surgery, Seoul, Republic of Korea
^c Department of Dermatology, Seoul National University Hospital, Seoul, Republic of Korea
^d Department of Pathology, Seoul National University Hospital, Seoul, Republic of Korea

^∗Reprint requests to: Byung Jun Kim, MD, Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Chongno-Gu, Seoul 03080, Republic of Korea.Department of Plastic and Reconstructive SurgerySeoul National University HospitalSeoul National University College of Medicine101, Daehak-ro, Chongno-GuSeoul03080Republic of Korea^∗Yoonjin Kwak, MD, PhD, Department of Pathology, Seoul National University Hospital, 101, Daehak-ro, Chongno-Gu, Seoul 03080, Republic of Korea.Department of PathologySeoul National University Hospital101, Daehak-ro, Chongno-GuSeoul03080Republic of Korea

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Abstract

Background

Subungual melanoma (SUM) has a poor prognosis because of delayed diagnosis. Its progression, consensus on surgical treatment, and correlation with clinical outcomes remain unclear.

Objective

We aimed to identify the pattern of dermal invasion in different locations of the nail apparatus and its relationship with prognosis.

Methods

In this retrospective review of surgically treated SUM patients between January 2011 and April 2019, the nail apparatus was divided into 5 anatomic subunits: the dorsal roof of proximal nail fold, ventral floor of proximal nail fold, germinal matrix, nail bed, and hyponychium. Invasions in the subunits were categorized using 3 criteria: no tumor, in situ tumor, or invasion.

Results

Among 44 cases of SUM, dermal invasion occurred mostly in the distal areas, with 11, 30, 18, 7, and 4 in the hyponychium, nail bed, germinal matrix, ventral floor of proximal nail fold, and dorsal roof of proximal nail fold, respectively. The patients with hyponychial invasion showed a significantly greater Breslow depth (P = .009), a higher rate of lymph node metastasis (P = .019), distant metastasis (P = .036), and shorter disease-free survival (P = .001).

Conclusion

Hyponychial invasion is an important prognostic predictor of SUM, given its strong association with invasion depth, metastatic progression, and disease-free survival. Patients with invasion in the hyponychium should undergo more strict workup, treatment, and surveillance.

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Key words : hyponychium, oncology, pathology, prognosis, subungual melanoma, surgical dermatology

Abbreviations used : GM, NB, SUM, VFPNF

Plan

Introduction

Methods

Study design

Histopathologic analysis

Clinical analysis

Statistical analysis

Results

Patient characteristics

Distribution of SUM in each nail subunit and correlation with high-risk factors

Dermal invasion in the hyponychium and correlation with clinicopathologic factors

Histologic landscape of invasion in each nail subunit and risk factors

Dermal invasion in each nail subunit and correlation with Breslow depth, total involvement score, and disease-free survival

Discussion

	Kwak and Kim contributed equally as the corresponding authors to this article.
	Funding sources: None.
	IRB approval status: Reviewed and approved by IRB; approval H-2004-132-1117.