Nail Unit En Bloc Excisions for Melanoma In Situ

In a presentation on nail unit en bloc excisions for melanoma in situ, Dr. Jenny discussed the surgical technique as an alternative to amputation, emphasizing the importance of preserving digit function. She detailed several critical tips for executing these excisions effectively, starting with the necessity of understanding the anatomy of the nail matrix to ensure complete removal of the affected area. This involves making precise incision lines, with the proximal cut positioned about three-quarters of the way from the proximal nail fold to the distal interphalangeal joint, and the lateral incisions aligned with the mid-lateral line of the digit. Dr. Jenny highlighted the role of local anesthesia, advocating for a traditional nerve block supplemented by a modified wing block to enhance patient comfort. Careful handling of the extensor tendon was emphasized, with reminders to avoid injuring it during the procedure. Ultimately, she demonstrated the importance of conducting the excision down to the bone while maintaining caution near the tendon to achieve complete excision of the nail unit affected by melanoma.