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\begin{document}

\title{Surgical excision methods for skin cancer involving the nail unit: a
systematic review}



\author[1]{Claire Hardie}%
\author[1]{Ryckie Wade}%
\author[2]{Justin Wormald}%
\author[3]{Brian Stafford}%
\author[1]{Faye Elliott}%
\author[1]{Julia Newton-Bishop}%
\author[4]{Donald Dewar}%
\affil[1]{University of Leeds Faculty of Medicine and Health}%
\affil[2]{Oxford University}%
\affil[3]{World Health Organization}%
\affil[4]{Leeds Teaching Hospitals NHS Trust}%


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  \date{June 18, 2024}


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\begin{abstract}
Introduction Skin cancer affecting the nail unit is rare but is
associated with morbidity, and melanoma has a high mortality rate. The
principal treatment is surgical excision and methods can be classified
into digit-sparing surgery or amputation. Digit-sparing surgery (wide
excision or Mohs surgery) may be safe and effective for malignancies
involving the nail unit in comparison to amputation if there is not bony
invasion. The objective was to assess the efficacy and safety of
different methods of surgical excision for skin cancer involving the
nail unit. Methods Prospective comparative studies (randomised
controlled, non-randomised controlled and prospective observational
studies) of surgical excision for skin cancer of the nail unit in all
participants were eligible for inclusion. We searched electronic
databases, trials registers and conference abstracts. We checked the
reference lists of included studies and related systematic reviews for
further references to relevant studies, and we contacted experts to
enquire if they were aware of any additional relevant trials. We used
standard methodological procedures expected by Cochrane. The primary
outcomes were overall survival, disease free survival and adverse
events/outcomes at 30 days. The secondary outcomes were quality of life
outcomes. We planned to use GRADE to assess the quality of the evidence
for each outcome. Results We did not identify any studies that met the
inclusion criteria for this review. We have been unable to assess our
outcomes of overall survival, disease free survival, adverse
events/effects and quality of life. Conclusions As we have not
identified any studies for inclusion, we are unable to assess the
efficacy and safety of different methods of surgical excision for skin
cancer involving the nail unit. Prospective research, ideally in the
form of a randomised trial, is required in this field. Registration
Cochrane Database of Systematic Reviews 2021, Issue 5. Art. No.:
CD014590.%
\end{abstract}%



\sloppy


\section*{Title}

{\label{title}}

\section*{Surgical excision methods for skin cancer involving the nail
unit: a systematic
review}

{\label{surgical-excision-methods-for-skin-cancer-involving-the-nail-unit-a-systematic-review}}

\section*{Short running Title}

{\label{short-running-title}}

\section*{Surgery for cancer of the nail
unit}

{\label{surgery-for-cancer-of-the-nail-unit}}

\textbf{Authors}

Claire Hardie {[}1,2{]}, Ryckie G Wade {[}1,2{]}, Justin CR Wormald
{[}3{]}, Brian Stafford {[}4{]}, Faye Elliott {[}1{]}, Julia
Newton-Bishop {[}1{]}, Donald Dewar {[}2{]}

{[}1{]} Leeds Institute of Medical Research, University of Leeds, Leeds,
UK

{[}2{]} Department of Plastic and Reconstructive Surgery, Leeds Teaching
Hospitals NHS Trust, Leeds, UK

{[}3{]} Nuffield Department of Orthopaedics, Rheumatology and
Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK

{[}4{]} World Health Organization / Consumers Health Forum / Health
Consumers' Council of WA, Perth, Australia

Contact Person: Claire Hardie (claire.hardie@nhs.net)

Department of Plastic and Reconstructive Surgery, Leeds Teaching
Hospitals NHS Trust, Leeds, UK

\textbf{Acknowledgements}

This project was supported by the National Institute for Health Research
(NIHR), via Cochrane Infrastructure funding to Cochrane Skin. The NIHR
had no role in the design, conduct or publication of the content,
research or evidence synthesis. The views and opinions expressed therein
are those of the authors and do not necessarily reflect those of the
Systematic Reviews Programme, NIHR, NHS or the Department of Health.

\textbf{Data availability statement}

Data sharing not applicable -- no new data generated

\textbf{Funding statement}

Ryckie Wade is supported by the National Institute for Health Research
(NIHR) in Leeds (DRF-2018--11-ST1-159). The views expressed are those of
the author(s) and not necessarily those of the United Kingdom's National
Health Service, NIHR or Department of Health and Social Care.

Justin Wormald is supported by the National Institute for Health
Research (NIHR) in Oxford (NIHR 301793). The views expressed are those
of the author(s) and not necessarily those of the United Kingdom's
National Health Service, NIHR or Department of Health and Social Care.

\textbf{Conflict of interest disclosure}

Claire Hardie: none known. Ryckie G Wade: none known. Justin CR Wormald:
none known. Brian Stafford: none known. Faye Elliott: none known. Julia
Newton-Bishop: my institution has received a grant from Cancer Research
UK to carry out research looking at melanoma survival. Daily fees were
paid to me when I was Clinical Lead at the National Institute for Health
and Care Excellence (NICE) for the Clinical Melanoma Guideline. I have
been reimbursed for travel expenses when asked to give talks at academic
meetings. None of these were paid from identifiable commercial entities;
conference organisers commonly pool funding sources including commercial
companies. I have done legal work for clinical negligence claims in the
past and the last case is~now coming to an end. These fees were
primarily used to support the research group but I did receive one fee
from one client personally. My research group is in receipt of a number
of research grants from Cancer Research UK, the Medical Research
Council, Melanoma Focus, Melanoma Research Alliance and the National
Institutes~of Health that are for research unrelated to this Cochrane
work. A single honorarium was accepted for a talk in 2019; paid to my
institution. I receive very small royalties for a textbook published
many years ago. I am invited to around three~meetings per year where my
travel costs are paid by the conference organisers. I have not travelled
to meetings where the costs are paid directly by a drug company. I have
listed grants and travel expenses paid to enable me to complete my
research but I do not believe that they reflect a conflict of interest
with respect to this Cochrane work. Donald Dewar: none known.

\textbf{Reporting guideline}

PRISMA 2020

\textbf{Hosted file}

\verb`Surgical excision methods for skin cancer involving the nail unit.docx`  available at \url{https://authorea.com/users/625537/articles/647500-surgical-excision-methods-for-skin-cancer-involving-the-nail-unit-a-systematic-review}

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