ABSTRACT
Squamous cell carcinoma (SCC) of the nail bed is rare, and it usually mimics a variety of diseases. Thus, a true diagnosis of subungual SCC may be delayed for years. The appearance of a subungual tumor at presentation is often non-diagnostic, and exploratory nail-plate removal with biopsy is recommended. We have experienced four patients with subungual SCC, and they were treated by Mohs micrographic surgery (MMS). In an average follow-up of 13.5 months, there was no recurrence in all cases. However, in one case, amputation was performed due to local periosteal invasion. In cases of subungual SCC without bone involvement, particular virtue of MMS over amputation is that it permits the preservation of both function and cosmesis of the nail unit. Since the maintenance of function is of the utmost priority, MMS can be considered the most appropriate technique, as it enables us to maximize the preservation of normal anatomy of the finger.
Subject(s)
Humans , Amputation, Surgical , Biopsy , Carcinoma, Squamous Cell , Fingers , Follow-Up Studies , Mohs Surgery , Nails , Recurrence , VirtuesABSTRACT
Subungual squamous cell carcinoma often presents with atypical clinical manifestations, which can lead to delays in diagnosis. The presence of a tumor can be masked by the presence of infections or other misleading pathological conditions. The authors report on techniques for adequate biopsy and excision of such tumors. A case of subungual squamous cell carcinoma with invasion into the underlying bone is presented. Clinical histopathological evidence is reviewed along with human papillomavirus typing. Accurate diagnosis requires a high index of suspicion and appropriate tissue sampling.
Subject(s)
Humans , Biopsy , Carcinoma, Squamous Cell , MasksABSTRACT
Subungual squamous cell carcinoma is a rare malignant tumor. It may clinically mimic a variety of benign inflammatory lesions and this frequently misdirects the clinician toward delaying proper treatment. In this article, a 62-year-old woman presented with a 2-year history of repeat swelling, erythema and severe pain on the left fourth fingernail. She had been frequently treated under the clinical impression of paronychia or onychomycosis. Despite the treatment, no improvement was noted. She had an incisional biopsy of the perionychium. The histologic diagnosis was revealed invasive, well-differentiated squamous cell carcinoma. On the whole body PET-CT, hypermetabolic lesion was found in the distal phalanx of the left fourth finger. She underwent amputation at the distal phalangeal joint. There has been no recurrence of tumor for one year after surgery. In conclusion, subungual squamous cell carcinoma is often mistaken for chronic inflammation. When resistance to treatments is observed, the possibility of malignancy must be considered and early biopsy is recommended.
Subject(s)
Female , Humans , Middle Aged , Amputation, Surgical , Biopsy , Carcinoma, Squamous Cell , Erythema , Fingers , Hydrazines , Inflammation , Joints , Nails , Onychomycosis , Paronychia , RecurrenceABSTRACT
PURPOSE: Subungual squamous cell carcinoma is a very rare malignant tumor of the digitus especially in toe making it very difficult to differentiate from tinea unguium, verruca vulgaris, eczema, pyogenic granuloma, and malignant melanoma due to their clinical similarities. Therefore this article reports on subungual squamous cell carcinoma of left 5th toe. METHODS: A patient visited at our hospital due to pain and incurable inflammation on left 5th toe with no improvement for four months. Despite of antibiotics and dressing for a week, treatment was ineffective. After excisional biopsy, he was diagnosed with subungual squamous cell carcinoma. And ray amputation and prophylactic inguinal lymph node dissection was done. RESULTS: The biopsy was showed irregular cells made up of anaplastic and squamous cells in the dermis and epidermis. And the inguinal lymph node showed no metastasis. The patient had been treated without significant complications or recurrence for a year. CONCLUSION: This article emphasizes the need of diagnostic biopsy on the subungual lesions that have resistance to the conventional treatments. And if that is subungual squamous cell carcinoma, complete resection of the lesion and prophylactic inguinal lymph node dissection is essential.
Subject(s)
Humans , Amputation, Surgical , Anti-Bacterial Agents , Bandages , Biopsy , Carcinoma, Squamous Cell , Dermis , Eczema , Epidermis , Granuloma, Pyogenic , Inflammation , Lymph Node Excision , Lymph Nodes , Melanoma , Neoplasm Metastasis , Onychomycosis , Recurrence , Toes , WartsABSTRACT
Squamous cell carcinoma of the nail bed is a low grade, slowly progressive, malignant neoplasm. A 66-year-old man had nail lesion on his right thumbnail for two years. After partial nail avulsion, an incisional biopsy was done. The histologic diagnosis was a squamous cell carcinoma. A radiological examination of digit was normal and no lymphadenopathy was palpable. The lesion was totally excised and surgical defect of nail bed was reconstructed by dermal graft. There was no recurrence of tumor till one year after surgery and out-look of nail recovered almost normal. When the underlying malignancy is suspected, it is necessary to examine the nail bed after partial nail avulsion. And application of dermal graft may be useful procedure for regeneration of nail plate when there is a large nail bed defect after excision.
Subject(s)
Aged , Humans , Biopsy , Carcinoma, Squamous Cell , Diagnosis , Lymphatic Diseases , Recurrence , Regeneration , TransplantsABSTRACT
Squamous cell carcinoma of the nail bed is a low grade, slowly progressive, malignant neoplasm. A 66-year-old man had nail lesion on his right thumbnail for two years. After partial nail avulsion, an incisional biopsy was done. The histologic diagnosis was a squamous cell carcinoma. A radiological examination of digit was normal and no lymphadenopathy was palpable. The lesion was totally excised and surgical defect of nail bed was reconstructed by dermal graft. There was no recurrence of tumor till one year after surgery and out-look of nail recovered almost normal. When the underlying malignancy is suspected, it is necessary to examine the nail bed after partial nail avulsion. And application of dermal graft may be useful procedure for regeneration of nail plate when there is a large nail bed defect after excision.
Subject(s)
Aged , Humans , Biopsy , Carcinoma, Squamous Cell , Diagnosis , Lymphatic Diseases , Recurrence , Regeneration , TransplantsABSTRACT
Subungual squamous cell carcinoma is a rare malignant tumor arising on the nail bed and it has resemblance to a variety of inflammatory skin diseases and cutaneous tumors. The diagnostic biopsy is essential but it is often delayed because of patients' reluctance, technical difficulties, or lack of awareness by physicians and inappropriate treatment is given for other suspected conditions, especially fungal or bacterial infections and for warts. We report two rare cases of subungual squamous cell carcinoma and emphasize the need of diagnostic biopsy on the subungual lesions that have resistance to the conventional treatments.
Subject(s)
Bacterial Infections , Biopsy , Carcinoma, Squamous Cell , Skin Diseases , WartsABSTRACT
Subungual squamous cell earcinoma is an uncommon disease. Diagnosis of this condition is often delayed because of a resemblance to a variety of benign inflammatory conditions such as onychomycosis, chronic paronychia, eczema, and verruca vulgaris. The importance of an early skin biopsy for a chronic nonhealing subungual lesion is stressed. We present a case of subungual squamous cell carcinoma iri a 75-year-old man who had a 3-year history of intermittent swelling, erythema, and tenderness on the left 5th toe. The patient complained of a tender whitish verrucous 1.5cm-sized mass which had been present for a few months. A Histopathological study revealed invasive, well differentiated squamous cell carcinoma.