Supplementary Material for: Melanoma of the Nail Apparatus: An Analysis of Patients’ Survival and Associated Factors

Background: There are no proper management guidelines for nail apparatus melanoma (NAM). Objective: This study aimed to describe the clinical features, the presence of locoregional and distant metastases and disease-free and overall survival of NAM treated at our institution. Methods: A retrospective cohort review of patients with single, primary localized histopathologically confirmed NAM was performed. Collected data consisted of patients’ characteristics and tumor features. In addition, local recurrence, locoregional metastases, distant metastases, disease-free survival (DFS) and overall survival (OS) were used as the main outcomes in our analysis. Results: Thirty patients with NAM were included. The overall survival (OS) in our patients at 5 and 10 years was 85.6 and 73.4%, respectively. DFS was significantly higher in patients with primary tumor location in the hand and without tumor-infiltrating lymphocytes (p value = 0.01 and 0.04, respectively). The patients with in situ melanoma or Breslow thickness <1 mm had a significantly higher chance of DFS and OS (90.0 and 94.1% at 5 years, respectively) than those with thicker NAM (58.3 and 55.6% at 5 years, respectively). A total of 53.3% of 30 patients underwent primary excision and covering with a full-thickness skin graft, while 13.3% of our 30 patients underwent digit amputation. The patients who underwent excision and covering with a full-thickness skin graft showed a complete overall survival (100% at 5 years). Conclusion: Primary tumor location in the hand and lower tumor thickness might be correlated with better patients’ survival. The study results suggest that total amputation might not be necessary in all NAM cases.

背景：甲黑素瘤（nail apparatus melanoma, NAM）目前尚无规范的诊疗指南。
目的：本研究旨在描述本机构收治的甲黑素瘤患者的临床特征、局部区域及远处转移发生情况，以及无病生存与总生存状况。
方法：本研究对经组织病理学确诊的单发原发性局限性甲黑素瘤患者开展了回顾性队列研究。收集的资料包括患者基线特征与肿瘤特征；此外，本研究以局部复发、局部区域转移、远处转移、无病生存（disease-free survival, DFS）及总生存（overall survival, OS）作为主要分析结局指标。
结果：本研究共纳入30例甲黑素瘤患者。本队列患者的5年、10年总生存率分别为85.6%与73.4%。原发肿瘤位于手部且无肿瘤浸润淋巴细胞的患者，其无病生存率显著更高（分别对应p值0.01与0.04）。与肿瘤厚度更高的患者相比，原位黑素瘤或布雷斯洛（Breslow）厚度<1mm的患者无病生存与总生存概率显著更高：前者5年无病生存与总生存率分别为90.0%与94.1%，后者则分别为58.3%与55.6%。30例患者中，共53.3%接受了原发灶切除联合全厚皮片移植修复，13.3%接受了指（趾）截除术。接受原发灶切除联合全厚皮片移植修复的患者，其5年总生存率达100%。
结论：原发肿瘤位于手部以及较低的肿瘤厚度，或与患者更佳的生存结局相关。本研究结果提示，并非所有甲黑素瘤患者均需接受完全截除手术。