Journal of the European Academy of Dermatology and Venereology : JEADV · 2026
Experience-based recommendations for the diagnosis and management of early-stage nail unit melanoma.
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Haneke Eckart, André Josette, Baran Robert, Cherit Judith Dominguez, Chiheb Soumiya, Di Chiacchio Nilton, Ralph Daniel C, Di Chiacchio Nilton Gioia, Göktay Fatih, Grover Chander, Jellinek Nathaniel, Kishi Akiko, Lee Dong Youn, Li Hang, Lipner Shari R, Mun Je-Ho, Ohara Kuniaki, Pasch Marcel C, Piraccini Bianca Maria, Richert Bertrand, Rigopoulos Dimitris, Rubin Adam I, Shemer Avner, Singal Archana, Soyer H Peter, Starace Michela, Tosti Antonella, Iorizzo Matilde
Аннотация
BACKGROUND: 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.
OBJECTIVES: To provide practical, experience-based recommendations for the diagnosis, differential diagnosis and management of early-stage NUM, developed by an international expert panel.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
OBJECTIVES: To provide practical, experience-based recommendations for the diagnosis, differential diagnosis and management of early-stage NUM, developed by an international expert panel.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.