Nail-bed melanoma.

In our series of 348 patients treated over a 10-year period, six (1.7%) had their primary lesions in the nail bed. Five of the subungual melanomas occurred in the toes and one in the thumb. Four of the lesions were of the acral lentiginous type. The delay in diagnosis was 7 months to 6 years. Four of the patients presented with advanced, neglected tumors. One had distant metastases at diagnosis. The treatment was mainly surgical. Digital amputation was carried out for local control. Five patients underwent lymph node dissection and in three of them regional metastases were found. Of the four patients with regional and distant metastases at the time of diagnosis, three died within 6 to 60 months and the fourth is alive with metastatic spread. Of the two patients with melanoma confined to the nail bed, one is free of disease 50 months following diagnosis and the other suffered from a local recurrence and has been free of disease for 30 months following wide excision and limb perfusion.