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
1 Department of Dermatology, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
2 Department of Dermatology, Kansai Medical University, Osaka, Japan
3 Department of Plastic Surgery, University of Saga, Saga, Japan

© 2017 Iino et al.

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: ( This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Dermatology, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka-Shimoaizuki, Eiheiji, Fukui 910-1193, Japan; Tel: +81-776-61-8367; Fax: +81-776-61-8112; E-mail:



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.


To seek out other superior management avoiding disadvantages associated with the conventional NUM surgery.


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.


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.


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.

Keywords: Nail unit melanoma, Dermal regeneration template, Preserved subcutaneous, Vascular network, Skin grafting, Surgery.