A Call for Evidence-Based Conservative Management of Nail Unit Malignancies

Nail unit squamous cell carcinoma and melanoma are the most common malignancies of the nail apparatus. Compared to their cutaneous counterparts, they are diagnosed later and perceived as more aggressive. This may result in overzealous management, including radiographic imaging with poor sensitivity and specificity, interventional nodal staging by sentinel lymph node biopsy, amputation over digit-sparing tumor resections, and elaborate reconstructions after tumor extirpation. In this review article, the authors evaluate the evidence behind several misconceptions in nail malignancy management and provide evidence-based guidance for more conservative care.