Nail apparatus melanoma : Moroccan case series and review of the literature

Background: Melanoma is a malignant tumour with an adverse prognosis. It arises in the nail unit in 1–3% of the cases. There are few studies dealing with this entity in particular in Morocco. Objective: The objective of this study was to explore the epidemiological, clinical and histological aspects of nail apparatus melanoma at the Dermatology Department of IBN ROCHD University Hospital in Casablanca. Material and Methods: We retrospectively analysed the epidemiological, clinical and histological characteristics of 34 patients diagnosed with nail apparatus melanoma (NAM) from 2009 to 2023. We compared our findings to those reported in the literature. Results: Thirty-four cases of nail melanoma were identified. A female predominance was observed with a sex ratio (M/F) of 0.47. The median age at diagnosis was 55 years, and the most common reason for consultation was an ulcerated nodule of the nail (50% cases). The fingernails were more commonly involved. In histopathology, nodular melanoma was the most frequent histological type (47%). Metastases were found in 47% cases. Excision of the nail unit was the reference treatment, performed in 67.64%. The overall 5-year survival rate was 46%. Conclusion: NAM in our cohort was associated with poor prognosis, mainly due to late diagnosis and restricted therapeutic resources. Early detection remains crucial to improving outcomes. Strengthening awareness and education among healthcare professionals and the public is essential to promote timely diagnosis and better management of this aggressive malignancy.