Reconstruction after wide excision of the nail apparatus for in situ or minimally invasive subungual melanoma: A retrospective case series

Nail apparatus reconstruction is feasible for in situ or minimally invasive SUM, particularly when the Breslow thickness is ≤0.5 mm. In invasive cases, immediate reconstruction risks being performed over residual tumor, supporting a two-stage approach, especially when donor site morbidity is expected. Techniques such as full-thickness skin grafts combined with a dermal matrix provide reliable functional and aesthetic outcomes. A two-stage approach is particularly valuable when oncologic margins are uncertain, as it reduces the risk of reconstructing over residual disease while preserving options with lower donor-site morbidity.