Please use this identifier to cite or link to this item: https://doi.org/10.1097/PAS.0b013e318073c600
Title: Subungual melanoma: A study of 124 cases highlighting features of early lesions, potential pitfalls in diagnosis, and guidelines for histologic reporting
Authors: Tan, K.-B. 
Moncrieff, M.
Thompson, J.F.
McCarthy, S.W.
Shaw, H.M.
Quinn, M.J.
Li, L.-X.L.
Crotty, K.A.
Stretch, J.R.
Scolyer, R.A.
Keywords: Acral lentiginous
Diagnosis
Finger
Melanoma
Nail
Nevus
Pathology
Prognosis
Sentinel node
Subungual
Toe
Issue Date: Dec-2007
Source: Tan, K.-B., Moncrieff, M., Thompson, J.F., McCarthy, S.W., Shaw, H.M., Quinn, M.J., Li, L.-X.L., Crotty, K.A., Stretch, J.R., Scolyer, R.A. (2007-12). Subungual melanoma: A study of 124 cases highlighting features of early lesions, potential pitfalls in diagnosis, and guidelines for histologic reporting. American Journal of Surgical Pathology 31 (12) : 1902-1912. ScholarBank@NUS Repository. https://doi.org/10.1097/PAS.0b013e318073c600
Abstract: Subungual melanoma (SUM) is an uncommon variant of melanoma that is often difficult to diagnose, both clinically and pathologically. In an attempt to provide pathologic clues to diagnosis, especially in early lesions or small biopsies, and to provide practical advice to pathologists in reporting, the clinicopathologic features of 124 cases of SUM were reviewed, the largest series reported to date. The features of 28 cases of subungual melanoma in situ (MIS), comprising 4 cases of MIS and 24 cases where areas of MIS were present adjacent to dermal-invasive SUMs, were compared with those of a similar number of acral nevi to identify useful distinguishing features. The median age of the patients was 59 years and the most common site was the great toe (24%). Nine percent of cases were AJCC stage 0, 14% were stage I, 41% were stage II, 32% were stage III, and 4% were stage IV at initial diagnosis. The commonest histogenetic subtype was acral lentiginous (66%), followed by nodular (25%) and desmoplastic (7%). The majority of tumors were locally advanced at presentation with 79% being Clark level IV or V. The median Breslow thickness was 3.2 mm. The median mitotic rate was 3 per mm and 33% of cases demonstrated primary tumor ulceration. Seven of 29 patients (24%) who underwent a sentinel lymph node biopsy had nodal disease. Multivariate Cox-regression analysis showed higher disease stage to be the only significant predictor of shortened survival. In comparison to acral nevi, MIS more frequently showed lack of circumscription, a prominent lentiginous growth pattern, predominance of single cells over nests, moderate-to-severe cytologic atypia, a dense and haphazard pagetoid intraepidermal spread of melanocytes, and the presence of junctional/ subjunctional lymphocytes ("tumor infiltrating lymphocytes"). Tumor infiltrating lymphocytes have not been highlighted previously as a feature of subungual MIS and represent a useful diagnostic clue. Guidelines for the reporting of SUMs are also presented. Knowledge and recognition of the pathologic features of SUMs and the important features that distinguish them from nevi should reduce the frequency of misdiagnosis. © 2007 Lippincott Williams & Wilkins, Inc.
Source Title: American Journal of Surgical Pathology
URI: http://scholarbank.nus.edu.sg/handle/10635/130597
ISSN: 01475185
DOI: 10.1097/PAS.0b013e318073c600
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