10.5826/dpc.1304a226
text/xml
2160-9381
3215
en
Je-Ho Mun
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
Successful Management of Periungual Acral Lentiginous Melanoma Using Secondary Intention Healing 
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Image Letter
2023-10-31
2023-02-04
2023-10-31
2024-01-15
e2023226
Dermatol Pract Concept
Je-Ho Mun
2023/10/31
10.5826/dpc.1304a226
e2023226
Department of Dermatology, Seoul National University College of Medicine; Department of Dermatology, Seoul National University Hospital, Seoul, Korea
2160-9381
en
e2023226
Darmawan CC, Ohn J, Mun JH, et al. Diagnosis and treatment of nail melanoma: a review of the clinicopathologic, dermoscopic, and genetic characteristics. J Eur Acad Dermatol Venereol. 2022;36(5):651-660. PMID: 35098589.
Successful Management of Periungual Acral Lentiginous Melanoma Using Secondary Intention Healing 
https://dpcj.org/index.php/dpc/article/download/3215/2376
           Successful Management of Periungual
        Acral Lentiginous Melanoma Using Secondary
                      Intention Healing
                                                Min Jae Kim1,2, Je-Ho Mun1,3


1 Department of Dermatology, Seoul National University College of Medicine, Seoul, Republic of Korea
2 Department of Dermatology, Seoul National University Bundang Hospital, Seongnam, Korea
3 Department of Dermatology, Seoul National University Hospital, Seoul, Korea



Citation: Kim MJ, Mun JH. Successful Management of Periungual Acral Lentiginous Melanoma Using Secondary Intention Healing.
Dermatol Pract Concept. 2023;13(4):e2023226. DOI: https://doi.org/10.5826/dpc.1304a226
Accepted: April 15, 2023; Published: October 2023
Copyright: ©2023 Kim et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use,
distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing Interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding Author: Je-Ho Mun, MD, PhD, Department of Dermatology, Seoul National University College of Medicine, 101
Daehak-ro, Jongno-gu, 110-744 Seoul, Republic of Korea. Telephone: 82-2-2072-2417, Fax: 82-2-742-7344, Email: jehomun@gmail.com




Case Presentation                                                        examination and ultrasonographic evaluation of the axillary
                                                                         lymph node at the 24-month follow-up after surgery.
A 74-year-old man presented with a pigmented patch on
the hyponychium and the distal nail bed of the left thumb.
                                                                         Teaching Point
Dermoscopy revealed a parallel ridge pattern (Figure 1A).
A skin biopsy demonstrated scattered atypical melanocytic                Ungual melanoma that generally occurs in the nail matrix
proliferation in the epidermis, consistent with acral lentigi-           requires en bloc excision of the nail apparatus, resulting in
nous melanoma in situ. The patient underwent wide excision               total nail loss [1,2]. However, if it is detected and treated
with a 5-mm margin. Secondary intention healing (SIH) was                at an early stage, melanoma arising from periungual skin
used to resolve the surgical defect (Figure 1B). Granulation             can have a chance for nail preservation. This report shares
tissue formation and re-epithelialization occurred within                our experience of successfully managing the surgical defect
3 weeks and were completed within 12 weeks after surgery                 in periungual acral melanoma with SIH after wide excision.
(Figure 1, C and D). The original shape of the thumb and the             Unlike skin grafting leading to digit deformity and unsat-
nail was restored after 7 months (Figure 1, E and F). There              isfactory cosmesis, SIH promotes the natural regeneration
was no evidence of recurrence or metastasis based on clinical            of the nail unit. Therefore, the tissue left to heal by itself




Image Letter | Dermatol Pract Concept. 2023;13(4):e2023226                                                                           1
Figure 1. (A) Acral lentiginous melanoma in situ with irregular pigmentation affecting the distal nail bed and periungual skin of the left
thumb. (B) Surgical defect involving the distal nail bed after wide excision. (C-F) Serial photographs during secondary intention healing after
wide excision of acral lentiginous melanoma in situ: (C) at week 3, (D) at week 8, (E) at week 16, and (F) at week 30.



can replace the unique characteristics of the nail bed and the            References
periungual acral skin with dermatoglyphics [1].
    Another teaching point of the present case is that der-                1. Rubin AI, Jellinek NJ, Daniel CR III, et al. Scher and Daniel’s
                                                                              Nails: Diagnosis, Surgery, Therapy. 4th ed. New York, NY:
moscopy helped meticulous evaluation of the borders in
                                                                              p 39–82, p 243–268. Springer; 2018.
periungual melanoma during surgery. We believe that new
                                                                           2. Darmawan CC, Ohn J, Mun JH, et al. Diagnosis and treatment
technologies, including dermoscopy and confocal micros-                       of nail melanoma: a review of the clinicopathologic, dermo-
copy, enable physicians to define surgical margins more                       scopic, and genetic characteristics. J Eur Acad Dermatol Vene-
accurately.                                                                   reol. 2022;36(5):651-660. PMID: 35098589.




2                                                                                Image Letter | Dermatol Pract Concept. 2023;13(4):e2023226
