Authors
Eckart Haneke, Josette André, Robert Baran, Judith Dominguez Cherit, Soumiya Chiheb, Nilton Di Chiacchio, C Ralph Daniel, Nilton Gioia Di Chiacchio, Fatih Göktay, Chander Grover, Nathaniel Jellinek, Akiko Kishi, Dong Youn Lee, Hang Li, Shari R Lipner, Je-Ho Mun, Kuniaki Ohara, Marcel C Pasch, Bianca Maria Piraccini, Bertrand Richert, Dimitris Rigopoulos, Adam I Rubin, Avner Shemer, Archana Singal, H Peter Soyer, Michela Starace, Antonella Tosti, Matilde Iorizzo
Published in
Journal of the European Academy of Dermatology and Venereology : JEADV. Oct 13, 2026. Epub Oct 13, 2026.
Abstract
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.
To provide practical, experience-based recommendations for the diagnosis, differential diagnosis and management of early-stage NUM, developed by an international expert panel.
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.
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.
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.
PMID:
42865149
Bibliographic data and abstract were imported from PubMed on 13 Oct 2026.
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