Secondary Intention Healing after Functional Surgery for Melanoma of the Nail Apparatus: Functional, Cosmetic, and Patient Satisfaction Results.

Functional surgery is the preferred approach for nail melanoma in situ (NMIS) and minimally invasive nail melanoma (MINM, Breslow ≤0.5 mm). Secondary intention healing (SIH) offers an alternative to traditional skin grafting, with favorable cosmetic, functional, and satisfaction outcomes and minimal complications. Six patients (mean age 54.8 years; 4 SMIS, 2 MISSM) underwent functional surgery with SIH. Healing times (granulation [T1] and re-epithelialization [T2]), complications, and outcomes were assessed at 12 weeks using QUICK-DASH, VBSAS, VAS, satisfaction scores, and DLQI. Mean T1 and T2 were 2.83 and 8.45 weeks, respectively. One patient experienced intense postoperative pain; another had a late nail spike. No hyperpigmentation or recurrences were observed. Outcomes: QUICK-DASH 18.92%; VBSAS 2.8 (12 weeks) and 0.25 (24 weeks); VAS 2; DLQI 2; and satisfaction 9.8/10 (10/10 after amputation discussion). SIH provides an effective alternative to grafting, allowing acceptable healing times, flexibility for margin extension or amputation, and excellent cosmetic, functional, and satisfaction outcomes with minimal complications.