*Konrad Wroński1, Zbigniew Masłowski2, Leszek Frąckowiak1, Przemysław Stefaniak2
Treatment subungual melanoma in foot – case report
1Department of Oncology, Faculty of Medicine, University of Warmia and Mazury, Olsztyn, Poland
Head of Department: prof. Sergiusz Nawrocki, MD, PhD
2Department of Surgical Oncology, Hospital Ministry of Internal Affairs with Warmia and Mazury Oncology Centre, Olsztyn, Poland
Head of Department: Andrzej Lachowski, MD
Subungual melanoma is rare disease and has worse prognosis than cutaneous melanoma in other places. This type of melanoma is observed accounting for 1 to 3% of all cutaneous melanoma in Caucasians. It is estimated that 1 of every 39 people in the western countries will be diagnosed melanoma of the skin during lifetime. The number of patients with skin melanoma is increasing and cause a growing economic problem for health care. Dermoscopy or videos dermoscopy is the basis for the initial diagnosis of melanoma of the skin. Sensitivity dermoscopy is up to 96.3% and the specificity up to 94.2%. The literature on dermoscopic examination of the nails is limited to very few published observations. Large number of information is available on dermoscopy of pigmented lesions elsewhere on the body skin. Dermoscopy can help clinicians accurately decide if a biopsy of the nail apparatus is necessary in cases of melanoma suspicious. Surgical biopsy of the lesion is the gold standard for diagnosis subungual melanoma. The „gold standard” of treatment is surgical amputation and sentinel lymph node biopsy. In this article the authors presented a case of a woman who was admitted to the hospital because of subungual melanoma in foot. The patient underwent amputation of toe with sentinel lymph node biopsy and in the second day after surgery was discharged home.
Subungual melanoma is rare disease and has worse prognosis than cutaneous melanoma in other places (1). This type of melanoma is observed accounting for 1 to 3% of all cutaneous melanoma in Caucasians (1). It is estimated that 1 of every 39 people in the western countries will be diagnosed melanoma of the skin during lifetime (2). The number of patients with skin melanoma is increasing and cause a growing economic problem for health care.
A 71-year-old woman, Caucasian race, was admitted to the Department of Surgical Oncology because of diagnosed subungual melanoma of the right feet. In an interview with the patient, she informed us that the black spot under the nail was observed three months earlier and gradually expanded. The patient reported no pain in the area of melanoma. Surgical biopsy showed subungual melanoma.
She had no any other symptoms, there was no history of weight loss and loss of appetite. The patient was treated chronically with hypertension and ischemic heart disease. She had no surgeries before and there was no history of carcinoma (especially skin melanoma) in patient family. Blood test and other routine hematological examinations and biochemical tests were within normal limits.
On physical examination, the right great toe nail plate was changed by the a fungal infection with a prominent black spot with a diameter of about 5 mm under the nail (fig. 1). There were not enlarged inguinal lymph nodes. Also ultrasound examination of the inguinal lymph nodes did not show pathologically enlarged lymph nodes.
Fig. 1. Subungual melanoma in right foot.
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