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Recurrence rates similar between functional surgery, amputation for nail melanoma

17 Sep 2019

Functional surgery (FS) and amputation both confer comparable rates of local recurrence of in situ or minimally invasive nail melanoma, reports a recent meta-analysis.

Accessing the databases of the Cochrane Library, Embase, PubMed, trial registries and other gray literature repositories, researchers retrieved five observational studies. The cumulative sample included 109 patients, of whom 88 underwent FS while 21 were amputated. The initial search found no eligible randomized controlled trials.

Pooled analysis revealed no significant difference between the two interventions in terms of local malignancy recurrence (odds ratio [OR], 1.57, 96 percent CI, 0.31–8.00). Heterogeneity of evidence was insignificant, as was the risk of publication bias, as measured by the Egger regression test (p=0.478).  

Subsequent subgroup analysis including only patients with nail melanoma in situ (n=107) did not meaningfully change the initial findings. The risk of local recurrence remained comparable between interventions (1.81, 0.35–9.31), with insignificant heterogeneity of evidence.

Several important limitations should be taken note of, said researchers. Among these are the inclusion of only five studies and the lack of any randomized trials eligible for inclusion.

Moreover, “in some aspects, FS is more complicated than amputation due to the unique nail anatomy and the subsequent intricacies in obtaining clear surgical margins,” they explained. This may restrict the widespread application of this intervention.

The present findings show that “conservative surgery is recommended as the first-line treatment option to avoid severe functional deficit after amputation,” the researchers noted. “To produce more solid evidence on this topic, future data with more observational studies with large sample size or randomized controlled trials are necessary.”

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