CASE REPORT
Two-phase Surgery Using a Dermal Regeneration Material for Nail Unit Melanoma: Three Case Reports
Shiro Iino1, *, Suguru Sato1, Natsuki Baba1, Naoki Maruta1, Wataru Takashima1, Noritaka Oyama1, Takahiro Kiyohara2, Masato Yasuda3, Minoru Hasegawa1
Article Information
Identifiers and Pagination:
Year: 2017Volume: 11
First Page: 81
Last Page: 86
Publisher ID: TODJ-11-81
DOI: 10.2174/1874372201711010081
Article History:
Received Date: 30/07/2017Revision Received Date: 6/10/2017
Acceptance Date: 22/10/2017
Electronic publication date: 31/10/2017
Collection year: 2017
open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: (https://creativecommons.org/licenses/by/4.0/legalcode). This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Abstract
Background:
Nail unit melanoma (NUM) poses a considerable treatment challenge, particularly in cases with in situ or early invasive lesions, and wide excision with phalanx amputation. For post-excisional skin defects, stump plasty and/or split-thickness skin grafting may cause persisted irritation and ulceration as a post-operative complication, because of the insufficient underlying tissue volume, vascularity, and stability.
Objective:
To seek out other superior management avoiding disadvantages associated with the conventional NUM surgery.
Method:
Three consecutive cases with NUM were treated by a novel two-phase surgical procedure using a commercially available dermal regeneration template; as the first phase, the lesional nail unit was excised and subsequently covered by a dermal regeneration template onto the phalangeal bone surface, allowing development of robust granulation with extracellular matrix and vascular network. Thereafter, the second phase employed a full-thickness skin grafting.
Results:
All three cases accomplished complete removal of the NUM lesion, and achieved a good cosmetic and functional outcome, maintaining physiological firmness, contour, and less contraction and atrophy of the overlying skin. They did not complain of major post-operative complications.
Conclusion:
Our two-phase approach using a dermal regeneration material is a satisfactory and straightforward technique, achieving a substantial benefit functionally and cosmetically in the post-operative period. We propose that the additional use of a tissue regeneration material can provide superior results for the reconstruction step of excised NUM.