Experience‐based recommendations for the diagnosis and management of early‐stage nail unit melanoma

BACKGROUND: Nail unit melanoma (NUM) is a distinct form of melanoma that most often arises from the nail matrix. No recommendations as to the management of nail melanoma, particularly of early-stage melanoma (in situ, stage IA, IB), exist. OBJECTIVES: To provide practical, experience-based recommendations for the diagnosis, differential diagnosis and management of early-stage NUM, developed by an international expert panel. METHODS: Based on clinical and histopathological experience and an extensive literature search, the authors present recommendations for the management of patients with lesions suspicious for NUM. RESULTS: Clinically, most cases present as a longitudinal pigmented band in an adult nail. It represents 1.5-2.5% of all melanomas in Caucasians but up to 50% in Black patients. Considering that the nail unit surface area accounts for less than 1% of the total body surface, the nail matrix can be regarded as a hotspot for melanoma development. Early diagnosis is critical, as treatment at the in situ or minimally invasive stage is associated with high cure rates. While dermoscopy is a useful diagnostic aid, nail matrix biopsy with histopathology remains the gold standard. Laboratory tests and standard imaging studies are not diagnostic; however, they may assist in surgical planning for advanced cases. Complete surgical excision is the treatment of choice. Wide local excision is recommended for early-stage disease, with specific margins (6 mm for standard lesions; 10 mm in the presence of the Hutchinson sign). Amputation is generally reserved for thicker tumours (>1 mm). A 10-year follow-up period is recommended to monitor for potential recurrence. CONCLUSIONS: Early diagnosis and treatment of nail unit melanoma at the in situ or minimally invasive stage (IA/IB) are associated with high cure rates. In contrast, advanced disease with deep invasion or metastasis carries a poor prognosis-therefore, timely recognition and intervention are essential to optimize outcomes.

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Publication Details

Journal
Journal of the European Academy of Dermatology and Venereology
Published
2026-10-13
DOI
https://doi.org/10.1111/jdv.70790
Primary Topic
Cutaneous Melanoma Detection and Management
Type
article
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article

Experience‐based recommendations for the diagnosis and management of early‐stage nail unit melanoma

Akiko Kishi, Marcel C. Pasch, Fatih Göktay, Chander Grover et al.
Journal of the European Academy of Dermatology and Venereology
Cutaneous Melanoma Detection and Management
article

Experience‐based recommendations for the diagnosis and management of early‐stage nail unit melanoma

Akiko Kishi, Marcel C. Pasch, Fatih Göktay, Chander Grover, Archana Singal, Soumiya Chiheb, Eckart Haneke, Matilde Iorizzo, Je‐Ho Mun, Avner Shemer, Shari R. Lipner, Nilton Gióia Di Chiacchio, Judith Domínguez‐Cherit, Dimitrios Rigopoulos, Dong‐Youn Lee, Michela Valeria Rita Starace, Kuniaki Ohara, Bertrand Richert, Nilton Di Chiacchio, Bianca Maria Piraccini, Adam I. Rubin, Robert Baran, Nathaniel Jellinek, H. Peter Soyer, Antonella Tosti, C. Ralph Daniel, Hang Li, Josette André
article en

Abstract

BACKGROUND: Nail unit melanoma (NUM) is a distinct form of melanoma that most often arises from the nail matrix. No recommendations as to the management of nail melanoma, particularly of early-stage melanoma (in situ, stage IA, IB), exist. OBJECTIVES: To provide practical, experience-based recommendations for the diagnosis, differential diagnosis and management of early-stage NUM, developed by an international expert panel. METHODS: Based on clinical and histopathological experience and an extensive literature search, the authors present recommendations for the management of patients with lesions suspicious for NUM. RESULTS: Clinically, most cases present as a longitudinal pigmented band in an adult nail. It represents 1.5-2.5% of all melanomas in Caucasians but up to 50% in Black patients. Considering that the nail unit surface area accounts for less than 1% of the total body surface, the nail matrix can be regarded as a hotspot for melanoma development. Early diagnosis is critical, as treatment at the in situ or minimally invasive stage is associated with high cure rates. While dermoscopy is a useful diagnostic aid, nail matrix biopsy with histopathology remains the gold standard. Laboratory tests and standard imaging studies are not diagnostic; however, they may assist in surgical planning for advanced cases. Complete surgical excision is the treatment of choice. Wide local excision is recommended for early-stage disease, with specific margins (6 mm for standard lesions; 10 mm in the presence of the Hutchinson sign). Amputation is generally reserved for thicker tumours (>1 mm). A 10-year follow-up period is recommended to monitor for potential recurrence. CONCLUSIONS: Early diagnosis and treatment of nail unit melanoma at the in situ or minimally invasive stage (IA/IB) are associated with high cure rates. In contrast, advanced disease with deep invasion or metastasis carries a poor prognosis-therefore, timely recognition and intervention are essential to optimize outcomes.

Journal of the European Academy of Dermatology and Venereology
Université Libre de Bruxelles (BE), Seoul National University (KR), University of Miami (US), Radboud University Nijmegen (NL), Tel Aviv University (IL), The University of Queensland (AU), University College of Medical Sciences (IN), Brown University (US), Sheba Medical Center (IL), University Hospital of Bern (CH), Samsung Medical Center (KR), Guru Teg Bahadur Hospital (IN), Radboud University Medical Center (NL), University of Mississippi Medical Center (US), Turkish Society of Hematology (TR), Hospital do Servidor Público Municipal (BR), IRCCS Azienda Ospedliero-Universitaria di Bologna Policlinico di Sant'Orsola (IT), Centre Hospitalier Universitaire Brugmann (BE), Hospital General Dr. Manuel Gea Gonzalez (MX), Université Mohammed VI des Sciences et de la Santé (MA), Andreas Sygros Hospital (GR), Peking University First Hospital (CN), Hôpital Universitaire International Cheikh Khalifa (MA), Centre Hospitalier Universitaire de Saint-Pierre (BE), Turkish Society of Cardiology (TR), Toranomon Hospital (JP), Weill Cornell Medicine (US), New York University (US), Sungkyunkwan University (KR)
Openalex Percentile: Top 17%
Cutaneous Melanoma Detection and Management
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