Funding sources No external funding.
DERMATOLOGICAL SURGERY AND LASERS
Perioperative confocal microscopy of the nail matrix in the management of in situ or minimally invasive subungual melanomas
Article first published online: 25 JUL 2012
© 2012 The Authors. BJD © 2012 British Association of Dermatologists
British Journal of Dermatology
Volume 167, Issue 4, pages 828–836, October 2012
How to Cite
Debarbieux, S., Hospod, V., Depaepe, L., Balme, B., Poulalhon, N. and Thomas, L. (2012), Perioperative confocal microscopy of the nail matrix in the management of in situ or minimally invasive subungual melanomas. British Journal of Dermatology, 167: 828–836. doi: 10.1111/j.1365-2133.2012.11013.x
This work was supported in part by grants to L.T. from Lyon 1 University, the Hospices Civils de Lyon and the Ligue Contre le Cancer du Rhone.
Conflicts of interest None declared.
- Issue published online: 26 SEP 2012
- Article first published online: 25 JUL 2012
- Accepted manuscript online: 7 JUN 2012 01:05PM EST
- Accepted for publication 15 April 2012
Background Although dermoscopy of the nail plate is helpful to discriminate between benign and malignant causes of nail pigmentations, there remain ambiguous cases in which a matricial biopsy is required. When a subungual melanoma is diagnosed histopathologically, a complementary surgical treatment is performed secondarily, the duration of postoperative disability being accordingly prolongated.
Objectives The purpose of our study was to evaluate the feasibility of an intraoperative diagnosis by reflectance confocal microscopy (RCM).
Patients and methods Our series included nine consecutive patients who underwent a matricial biopsy for an acquired melanonychia (one benign lentigo and eight melanomas). RCM examination was performed in vivo on the nail matrix after reclination of the nail plate, and/or ex vivo on the fresh tissue biopsy. RCM data were compared with histopathology.
Results There was a good correlation between confocal and histopathological features. Seven melanoma cases were unequivocally diagnosed intraoperatively according to the confocal features, whereas the lentigo was correctly classified as a benign lesion according to RCM. The remaining lesion could not be unequivocally classified by RCM and corresponded histopathologically to an early melanoma that required immunostaining to be diagnosed.
Conclusions Intraoperative RCM examination of the nail matrix is an efficient diagnostic approach of melanonychia striata that permits an extemporaneous diagnosis of malignancy and therefore a one-step surgical treatment of in situ or minimally invasive melanoma, reducing dramatically the duration of postoperative disability.