**5. Treatment**

SUM in situ must be surgically removed with wide resection of the entire nail unit with a 5-mm-wide margin and periosteum depth (**Figure 6**).

Reconstruction can be performed with the next finger banner flap and a full thickness graft, or it heals by the second intention with good functional results [1]. Treatment for invasive SUM is amputation of the phalanx.

Sentinel lymph node biopsy should be performed in SUM with Breslow depth >1 mm and in SUM >0.8 mm with ulceration [1, 9–11].

The most important factors for prognosis and survival are Breslow depth, ulceration, and nodal status at diagnosis [10, 11].

SUM has the same prognostic factors as other subtypes of melanoma. The adverse outcomes associated with SUM are due to delay in diagnosis because of a lack in recognition by health professionals and advanced stages at diagnosis.

**73**

**Author details**

Mariana Catalina De Anda Juárez

González" General Hospital, Mexico City, Mexico

provided the original work is properly cited.

\*Address all correspondence to: mdeanda73@gmail.com

Department of Dermatology and Dermatologic surgery, "Dr. Manuel Gea

© 2019 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

*Subungual Melanoma*

*DOI: http://dx.doi.org/10.5772/intechopen.85450*

**Figure 6.** *Resection of the nail unit with 5 mm wide margins and periosteum depth.*

*Subungual Melanoma DOI: http://dx.doi.org/10.5772/intechopen.85450*

*Cutaneous Melanoma*

ulceration.

**5. Treatment**

epithelial stromal interface is frequent [6, 7]. In some cases of SUM with lentiginous growth of single atypical melanocytes, immunohistochemical stains with

Invasive SUM has denser proliferation of atypical melanocytes arranged in aggregates and sheaths and may lead to nail dystrophy, nail destruction, and

It can be difficult to measure Clark level and Breslow thickness, because the distinction of the onychodermis is not always clear and the underlying phalanx is

SUM in situ must be surgically removed with wide resection of the entire nail

Reconstruction can be performed with the next finger banner flap and a full thickness graft, or it heals by the second intention with good functional results [1].

Sentinel lymph node biopsy should be performed in SUM with Breslow depth

The most important factors for prognosis and survival are Breslow depth,

SUM has the same prognostic factors as other subtypes of melanoma. The adverse outcomes associated with SUM are due to delay in diagnosis because of a lack in recognition by health professionals and advanced stages at diagnosis.

unit with a 5-mm-wide margin and periosteum depth (**Figure 6**).

Treatment for invasive SUM is amputation of the phalanx.

>1 mm and in SUM >0.8 mm with ulceration [1, 9–11].

*Resection of the nail unit with 5 mm wide margins and periosteum depth.*

ulceration, and nodal status at diagnosis [10, 11].

MELAN-A and HMB-45 may ease the diagnosis.

separated by only a thin dermal collagen layer [6].

**72**

**Figure 6.**
