Nail apparatus melanoma has a poorprognosis with up to 50 of patients dying within 5 years of the diagnosis

Subungual melanoma has a poor prognosis. The reported 5-year survival rates range from 35% to 50%. Most patients present with advanced subungual melanoma; however, even early diagnosis is not a guarantee of a good prognosis. Women have a better prognosis than men. Factors contributing to a poor prognosis are delay in diagnosis and, as a result of this, inadequate treatment. The tumour may be mistaken for a traumatic dystrophy, and valuable time may be lost before the diagnosis is made.

Treatment depends on the stage of the disease. Levels I and II melanomas may be adequately treated by wide local excision, and repair of the defect with graft or flap. Amputation is usually advised for melanoma at levels more advanced than II. When the thumb has to be amputated, pollicization of a finger may provide a functional replacement. There would appear to be no relationship between the prognosis and the extent of the amputation, although metacarpo/metatarsophalangeal amputation is considered to be inadequate because of local recurrences. The rationale for elective lymph node dissection and/or isolated hyperthermic perfusion of the extremity with cytotoxic drugs is still under discussion. Immune enhancement such as BCG (bacillus Calmette-Guerin) therapy is used in some centres.

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