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.

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.

1.
Heaton
KM
,
el-Naggar
A
,
Ensign
LG
,
Ross
MI
,
Balch
CM
.
Surgical management and prognostic factors in patients with subungual melanoma
.
Ann Surg
.
1994
;
219
(
2
):
197
204
.
2.
Cochran
AM
,
Buchanan
PJ
,
Bueno
RA
Jr
,
Neumeister
MW
.
Subungual melanoma: a review of current treatment
.
Plast Reconstr Surg
.
2014
;
134
(
2
):
259
73
.
3.
Jo
G
,
Cho
SI
,
Choi
S
,
Mun
JH
.
Functional surgery versus amputation for in situ or minimally invasive nail melanoma: a meta-analysis
.
J Am Acad Dermatol
.
2019
;
81
(
4
):
917
22
.
4.
Flores-Terry
M
,
Romero-Aguilera
G
,
Mendoza
C
,
Franco
M
,
Cortina
P
,
Garcia-Arpa
M
, et al
.
Functional surgery for malignant subungual tumors: a case series and literature review
.
Actas Dermosifiliogr
.
2018
;
109
(
8
):
712
21
.
5.
Oh
BH
,
Lee
S
,
Park
JW
,
Lee
JY
,
Roh
MR
,
Nam
KA
, et al
.
Risk of recurrence of nail unit melanoma after functional surgery versus amputation
.
J Am Acad Dermatol
.
2023
;
88
(
5
):
1017
23
.
6.
Jo
G
,
Hur
K
,
Cho
SI
,
Mun
JH
.
Secondary intention healing after functional surgery for in situ or minimally invasive nail melanoma
.
Acta Derm Venereol
.
2020
;
100
(
13
):
adv00179
.
7.
Kim
JS
,
Park
SW
,
Choi
TH
,
Kim
NG
,
Lee
KS
,
Kim
JR
, et al
.
The evaluation of relevant factors influencing skin graft changes in color over time
.
Dermatol Surg
.
2008
;
34
(
1
):
32
9
.
8.
Oh
BH
,
Jang
HS
,
Lee
J
,
Choi
MJ
,
Nam
KA
,
Chung
KY
.
Delayed reconstruction for the non-amputative treatment of subungual melanoma
.
Ann Dermatol
.
2015
;
27
(
4
):
417
22
.
9.
Tosti
A
,
Zaiac
M
.
Commentary: new concept in reconstruction after nail unit excision for melanoma in situ
.
Dermatol Surg
.
2012
;
38
(
4
):
695
6
.
10.
Knackstedt
TJ
,
Baltz
JO
,
Wilmer
EN
,
Jellinek
NJ
.
Assessing patient outcomes after digit-sparing en bloc surgery of nail apparatus melanoma in situ using two validated surveys
.
J Am Acad Dermatol
.
2020
;
82
(
3
):
746
7
.
11.
Pigem
R
,
Estupiñán
Y
,
Podlipnik
S
,
Bennàssar
A
.
Free laminar thin band graft for nail unit defects
.
Dermatol Surg
.
2021
;
47
(
7
):
1039
40
.
12.
Duarte
AF
,
Correia
O
,
Barros
AM
,
Ventura
F
,
Haneke
E
.
Nail melanoma in situ: clinical, dermoscopic, pathologic clues, and steps for minimally invasive treatment
.
Dermatol Surg
.
2015
;
41
(
1
):
59
68
.
13.
Muneuchi
G
,
Tamai
M
,
Igawa
K
,
Kurokawa
M
,
Igawa
HH
.
The PNB classification for treatment of fingertip injuries: the boundary between conservative treatment and surgical treatment
.
Ann Plast Surg
.
2005
;
54
(
6
):
604
9
.
You do not currently have access to this content.