Thumb subungual melanoma: Is amputation necessary?

SummarySubungual melanoma is uncommon. Traditional teaching advocates amputation of the affected digit. Recent studies have shown that more distal levels of amputations do not compromise survival or recurrence rates. When the thumb is involved, functional and aesthetic loss can be substantial. We present a new conservative, digit-sparing approach in the treatment of subungual melanoma of the thumb. Four informed patients were recruited to undergo the new treatment. Local excision with 1 cm margins down to and including the periosteum was carried out. Reconstruction was with a local flap. There has been one recurrence and no deaths with a minimum of 6 years follow up. In selected cases, conservative management of subungual melanoma allows preservation of length and minimises disability.