Subungual melanoma (SUM) is a rare variant of melanoma. Recent studies have shown that conservative surgery has excellent oncological, functional, and cosmetic results for SUM in situ or minimally invasive… Click to show full abstract
Subungual melanoma (SUM) is a rare variant of melanoma. Recent studies have shown that conservative surgery has excellent oncological, functional, and cosmetic results for SUM in situ or minimally invasive SUM. After conservative surgery, nail spicules can develop as one of the delayed complications. A 27-year-old Korean man visited our department with longitudinal pigmentation on his first toenail of 6 years duration. Incisional nail matrix biopsy showed many atypical melanocytes. Wide excision of the nail unit and split-thickness skin graft were performed. Several months after the conservative surgery, nail spicules appeared on the lateral borders of the wide excision area. Complete excision of the nail spicule tissue was performed. Histopathology showed a small nail unit consisting of epithelial and mesenchymal tissue (Figure 1A). Epithelial tissue included nail matrix, nail bed epithelium, nail plate, and surrounding epidermis. There were no melanoma cells. Interestingly, the mesenchymal tissue below the nail matrix and nail bed epithelium showed fibroblastic cells and blood vessels. It looked different from the surrounding dermis (Figure 1B). To further characterize the
               
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