Melanoma of the Hand: Current Practice and New Frontiers

Abstract

Melanoma of the hand represents a complicated clinical entity. Anatomic features of the hand create challenges in successful management of melanoma not encountered elsewhere in the body. The objectives of this article are to outline current standards for managing melanoma of the hand including diagnosis, surgical, and chemotherapeutic management. Particular emphasis will be placed on currently debated topics of the role of sentinel lymph node biopsy, the role of Mohs micrographic surgery, tissue sparing management of subungual melanoma, and the consideration of melanoma of the hand as a distinct entity based on clinical and molecular studies.

Keywords: hand; melanoma; sentinel lymph node; subungual; upper extremity.

Figure 1

Subungual melanoma of the left thumb. Note pigmentation of the nail fold and faint pigmentation and abnormality of the nail plate.

Figure 2

Subungual melanoma of the right thumb. Note pigmentary changes extending onto the pulp and exophytic nature of the lesion.

Figure 3

After interphalangeal joint level amputation (patient from Figure 2).

Figure 4

Cross finger flaps used for closure of traumatic defects of the index and long fingers.

Figure 5

Donor site of the cross finger flaps prior to application of a full thickness skin graft.

Figure 6

A dissected reverse posterior interosseus artery flap for reconstruction of a dorsal hand defect with exposed tendon after infection. Not the pedicle based at the distal forearm.