Risk of recurrence of nail unit melanoma after functional surgery versus amputation - 14/04/23
, Solam Lee, MD, PhD b, c, Jung Won Park, MD a, Ju Yeong Lee, MD b, Mi Ryung Roh, MD, PhD d, Kyoung Ae Nam, RN, MSN, WOCN a, Kee Yang Chung, MD, PhD aAbstract |
Background |
Minimally invasive nail unit melanoma (NUM) can be treated with functional surgery (FS) instead of amputation.
Objective |
To determine risk factors associated with recurrence in NUM.
Methods |
We retrospectively reviewed patients with NUM between 2008 and 2022 at a tertiary referral center. Multivariable Cox regression models adjusted for male sex and Breslow thickness (BT) were generated. Receiver operating characteristic analysis was performed to determine optimal cut-off points of the BT for stratifying recurrence risk.
Results |
We evaluated 140 NUM cases (33 amputation and 107 FS). The mean BT values were 3.14 ± 2.62 mm (amputation) and 0.70 ± 1.36 mm (FS). Recurrence occurred in 10 (30.30%) patients with amputation and 23 (21.5%) with FS. Distant disease occurred in 10 (30.30%) patients with amputation and 8 (7.48%) with FS. Male sex, greater BT, amelanotic color, ulcers, and nodules were associated with greater risk for recurrence or distant disease. A BT of 0.8 mm was deemed the optimal cut-off for stratifying recurrence risk after surgery (odds ratio, 5.32; 95% CI, 2.04-13.85).
Limitations |
Small sample.
Conclusion |
FS can be considered for NUM with a BT < 0.8 mm, providing an amputation-sparing benefit. However, NUM with risk factors for recurrence requires patient counselling and close follow-ups.
Le texte complet de cet article est disponible en PDF.Key words : Breslow thickness, distant disease, functional surgery, nail unit melanoma, recurrence, survival
Abbreviations used : aHR, BT, FS, NPV, NUM
Plan
| Drs Oh and Solam Lee contributed equally to this article. |
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| Solam Lee is co-first author. |
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| Funding sources: This study was supported by a faculty research grant of Yonsei University College of Medicine (6-2020-0102). |
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| IRB approval status: This study was reviewed and approved by the Institutional Review Board of Yonsei University Health System (approval number: 4-2022-0335). |
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| Patient consent: Not applicable. |
Vol 88 - N° 5
P. 1017-1023 - mai 2023 Retour au numéro
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