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Is Subungual Melanoma of the Hand Effectively Managed with Distal Interphalangeal Amputation?
Simon L Ortiz, BA
1,2, Rafa Rahman, MD, MPH
3, Jessica Lavery, MS
2, Edward A Athanasian, MD
2,3; Talia R Chapman, MD
2,3(1)Weill Cornell Medical College, New York City, NY, (2)Memorial Sloan Kettering Cancer Center, New York City, NY, (3)Hospital for Special Surgery, New York City, NY
Introduction: Guidelines exist for wide local excision of melanoma, recommending margins of 1-2cm. There is limited evidence on whether despite close surgical margins, distal interphalangeal joint (DIPJ) amputation provides adequate margins for treatment of invasive subungual melanoma in the hand. This study seeks to identify whether DIPJ amputation is an adequate treatment for invasive subungual melanoma with an acceptable risk of recurrence.
Materials & Methods: Retrospective review was performed of patients with pathology-confirmed invasive subungual melanoma of the hand at a tertiary care oncologic hospital from 2002-2024. Patients were excluded if they underwent a procedure other than DIPJ amputation or if they were diagnosed with melanoma in situ. Descriptive statistical analysis was performed on patient demographics, tumor and surgical characteristics, recurrence rate, metastasis rate, and overall survival.
Results: 41 patients were included (median age 61 years, 44% female) with median follow up of 3.4 years.
The mean tumor thickness reported at index surgery was 3.7mm (SD 3.2mm). Mean surgical resection margin was 6.9mm (SD 5.5mm). There was recurrence in 3 patients, with 3-year recurrence rate of 9.1% [95% CI: 2.2-22]. Twelve patients (29%) had metastasis or positive sentinel lymph node biopsy on presentation. Five patients developed metastasis post-surgery, with a 3-year metastasis rate of 13% [3.0-30]. Overall, 3-year survival rate was 85% [73-98], and 5-year survival rate was 77% [63-94].
Conclusion: Our findings suggest that DIPJ amputation may be an adequate treatment for invasive subungual melanoma. This study warrants further prospective investigation to compare DIPJ amputation with more extensive resection.
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