Abstract
Introduction: Functional surgery is the preferred approach for nail melanoma in situ (NMIS) and minimally invasive nail melanoma (MINM, Breslow ≤0.5 mm). Secondary intention healing (SIH) offers an alternative to traditional skin grafting, with favorable cosmetic, functional, and satisfaction outcomes and minimal complications. Methods: Six patients (mean age 54.8 years; 4 SMIS, 2 MISSM) underwent functional surgery with SIH. Healing times (granulation [T1] and re-epithelialization [T2]), complications, and outcomes were assessed at 12 weeks using QUICK-DASH, VBSAS, VAS, satisfaction scores, and DLQI. Results: Mean T1 and T2 were 2.83 and 8.45 weeks, respectively. One patient experienced intense postoperative pain; another had a late nail spike. No hyperpigmentation or recurrences were observed. Outcomes: QUICK-DASH 18.92%; VBSAS 2.8 (12 weeks) and 0.25 (24 weeks); VAS 2; DLQI 2; and satisfaction 9.8/10 (10/10 after amputation discussion). Conclusions: SIH provides an effective alternative to grafting, allowing acceptable healing times, flexibility for margin extension or amputation, and excellent cosmetic, functional, and satisfaction outcomes with minimal complications.
Plain Language Summary
Surgery with digit preservation is the recommended treatment for early forms of nail melanoma (a type of skin cancer that affects the nails). When the melanoma is very thin or limited to the surface of the nail, allowing the wound to heal on its own (known as secondary intention healing or SIH) can be a good alternative to closing the wound after surgery. This method has shown good cosmetic and functional results, fewer complications, and high patient satisfaction. In this study, we evaluated 6 patients who underwent this type of surgery with SIH. We focused on how long it took for their wounds to heal, how much pain they experienced, cosmetic results, finger function, complications, and overall satisfaction. The wounds took around 8.5 weeks to heal completely. Patients reported good functional and cosmetic results. Their quality of life was minimally affected, with high satisfaction scores (9.8 out of 10). Importantly, no recurrences of melanoma or skin discoloration were observed. In conclusion, healing with SIH is a safe and effective option. It also allows flexibility if more tissue needs to be removed later while still providing excellent cosmetic and functional results.
