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Magtulis NS, Guevara BEK. A case of superficial acral fibromyxoma masquerading as squamous cell carcinoma of the thumb: A case report. J Cutan Pathol 2024. [PMID: 38940413 DOI: 10.1111/cup.14675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 06/09/2024] [Accepted: 06/12/2024] [Indexed: 06/29/2024]
Abstract
A wide spectrum of tumors may affect the periungual spaces of the digits. Superficial acral fibromyxoma (SAF) is a rare, benign soft tissue tumor with diverse clinical presentations. We present a case of a 55-year-old woman with a 2-year history of a solitary periungual tumor on the left thumb, subjected to multiple episodes of trauma. Initially suspected to be a periungual squamous cell carcinoma (SCC) based on clinical and dermoscopic features, the tumor was confirmed to be a CD34- SAF through histopathology and immunohistochemistry. Although CD34 immunoreactivity is common in SAF, one-third of these tumors, including this case, do not stain for this marker. Periungual SCC considered a "great mimicker of nail tumors," may resemble other benign nail tumors such as SAF. The patient underwent complete surgical excision with primary closure, resulting in no recurrence after 1 year. This case highlights SAF as an underrecognized benign entity that may manifest with features suspicious of malignancy, potentially leading to unnecessarily aggressive interventions. Recognizing SAF through accurate biopsy techniques and thorough histopathologic evaluation, even in the absence of CD34 reactivity, is crucial for appropriate treatment and preservation of hand function and appearance.
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Affiliation(s)
- Nadra S Magtulis
- Department of Dermatology, Southern Philippines Medical Center, Davao, Philippines
| | - Bryan Edgar K Guevara
- Department of Dermatology, Southern Philippines Medical Center, Davao, Philippines
- Southeast Dermatology, Davao, Philippines
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2
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Bray ER, Tosti A, Morrison BW. Update on Squamous Cell Carcinoma of the Nail Unit: An Human Papillomavirus-Associated Condition. Skin Appendage Disord 2024; 10:199-206. [PMID: 38835716 PMCID: PMC11147528 DOI: 10.1159/000537760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 02/08/2024] [Indexed: 06/06/2024] Open
Abstract
Background Squamous cell carcinoma (SCC) and SCC in situ (Bowen's disease) are the most common malignancies of the nail unit. They are frequently seen in men over 50 and most commonly affect the fingers. The role of high-risk human papillomavirus (HPV) infection has been identified as a key contributor to the development of nail unit SCC. Summary In this review, we aimed to summarize the current state of our understanding of how HPV contributes to nail unit SCC, the role of genitodigital transmission of HPV, and the clinical features of HPV-associated nail unit SCC. We also review current advances in the treatment of nail unit SCC, with a focus on the potential role of HPV vaccination in the treatment and prevention of nail unit SCC. Key Messages Nail unit SCC should be recognized as an HPV-associated disease. HPV vaccination may represent a non-surgical modality for the management of these challenging malignancies in the appropriate clinical setting.
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Affiliation(s)
- Eric R Bray
- Philip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Antonella Tosti
- Philip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Brian W Morrison
- Philip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
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Waterton K, Magro CM, Lipner SR. Nail Unit Squamous Cell Carcinoma with Onycholemmal Features: Case Report and Review of the Literature. Skin Appendage Disord 2023; 9:284-290. [PMID: 37564691 PMCID: PMC10410085 DOI: 10.1159/000529906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 02/17/2023] [Indexed: 08/12/2023] Open
Abstract
Introduction Onycholemmal carcinoma (OC) is a rare subtype of squamous cell carcinoma (SCC) that originates from the epithelium of the nail bed. It is characterized by distinct histopathologic features including small clusters of atypical squamous epithelium devoid of a granular layer, with abrupt onycholemmal keratinization. Case Presentation We present a case of a 75-year-old male with right thumbnail onycholysis, yellow-green nail plate discoloration, as well as bleeding and purulence of the lateral nail fold. Histopathologic evaluation revealed high-grade squamous dysplasia, small clusters of severely atypical epithelial cells, and a pattern of abrupt keratinization consistent with the diagnosis of SCC carcinoma with onycholemmal features. GMS and PAS staining indicated concomitant onychomycosis. Pathologic analysis also disclosed residual SCC and concomitant amyloidosis, possibly light chain related and hence reflective of his underlying multi-organ lymphoplasmacytic lymphoma. The patient subsequently underwent Mohs micrographic surgery. Conclusion Clinical presentation of nail unit SCC with onycholemmal features is highly variable, making differentiating between similarly presenting benign and malignant nail disorders particularly challenging. This case report demonstrates clinical and histopathological features of nail unit SCC with onycholemmal features to improve diagnosis and management.
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Affiliation(s)
- Kelita Waterton
- SUNY Downstate Health Sciences University College of Medicine, Brooklyn, NY, USA
| | - Cynthia M. Magro
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Shari R. Lipner
- Department of Dermatology, Weill Cornell Medicine, New York, NY, USA
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García-Lozano JA, Salerni G, Cardenas-de la Garza JA, Perez MR, Schreiber FG. Longitudinal Melanonychia as the Only Sign of in Situ Squamous Cell Carcinoma. Dermatol Pract Concept 2023; 13:dpc.1301a62. [PMID: 36892386 PMCID: PMC9946102 DOI: 10.5826/dpc.1301a62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2022] [Indexed: 02/04/2023] Open
Affiliation(s)
- José Alberto García-Lozano
- Universidad Autónoma de Nuevo León, Departamento de Introducción a la Clínica, Facultad de Medicina y Hospital Universitario "Dr. José E. González", Monterrey, Nuevo León, Mexico
| | - Gabriel Salerni
- Dermatology Department, Hospital Provincial del Centenario de Rosario, Universidad Nacional de Rosario, Santa Fe, Argentina
| | - Jesus Alberto Cardenas-de la Garza
- Universidad Autónoma de Nuevo León, Servicio de Reumatología, Facultad de Medicina y Hospital Universitario "Dr. José E. González", Monterrey, Nuevo León, México
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Xu W, Mao D, Wen G. Squamous Cell Carcinoma of the Nail Unit After Trauma: A Case Report. CLINICAL, COSMETIC AND INVESTIGATIONAL DERMATOLOGY 2022; 15:1737-1741. [PMID: 36043220 PMCID: PMC9420417 DOI: 10.2147/ccid.s381877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 08/17/2022] [Indexed: 11/23/2022]
Abstract
Squamous cell carcinoma of the nail unit (SCCNU) is a relatively uncommon tumor with a low rate of metastasis. SCCNU presents with nonspecific symptoms and signs, it is frequently misdiagnosed by dermatologists or surgeons. We report a patient with right-hand ring subungual squamous cell carcinoma who received inappropriate treatment due to a long-term misdiagnosis following trauma. This patient had been treated with acitretin combined with cefaclor, and a certain curative effect was seen, but finally, wide local excision was performed.
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Affiliation(s)
- Wen Xu
- Department of Dermatology, People's Hospital of Peking University, Beijing, 100044, People's Republic of China
| | - Dandan Mao
- Department of Dermatology, People's Hospital of Peking University, Beijing, 100044, People's Republic of China
| | - Guangdong Wen
- Department of Dermatology, People's Hospital of Peking University, Beijing, 100044, People's Republic of China
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Acuña Pinzon CL, Nieves Condoy JF, Rivera Marquez DA, Collazo Moreno ARJ, Cethorth Fonseca RK, Zúñiga Vázquez LA. Nail Cancer: Review of the Two Main Types of an Underestimated Disease. Cureus 2022; 14:e23856. [PMID: 35530873 PMCID: PMC9072075 DOI: 10.7759/cureus.23856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2022] [Indexed: 11/13/2022] Open
Abstract
Neoplastic lesions (benign or malignant) in the nail region are rare when compared to lesions in the rest of the skin. Despite advances in diagnostic modalities, their diagnosis is frequently delayed or overlooked for days, months, or even years when they are misrecognized or when their approach is not appropriate. Undoubtedly, malignant tumors are the most important lesions since an inopportune diagnosis or treatment can drastically change the patient's prognosis. A review of all the scientific evidence on the two main malignant neoplasms of the nail apparatus (melanoma and squamous cell carcinoma) was carried out using the PubMed search engine from 2003 to 2022, in order to expose the appropriate diagnostic approach and treatment of these nail lesions to avoid delays that obscure the prognosis of patients. This review does not include reconstruction modalities after lesion resection, but the emphasis is placed on the great functional impact they produce. Surgical treatment in the early stages is the most important when talking about prognosis and emphasizing it; systemic oncological management of advanced stages is not so deep.
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Fujibayashi S, Murata K, Shimizu T, Otsuki B, Masamoto K, Shimizu Y, Matsuda S. An Observational Survey of Nail and Skin of Spine Surgeons-Possible Damage by Occupational Ionizing Radiation Exposure. Spine Surg Relat Res 2021; 5:359-364. [PMID: 34966861 PMCID: PMC8668220 DOI: 10.22603/ssrr.2020-0204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 01/04/2021] [Indexed: 12/11/2022] Open
Abstract
Introduction Orthopedic surgeons are exposed to ionizing radiation daily. With the increase in the number of minimally invasive surgery performed under X-ray fluoroscopy, radiation exposure to unprotected fingers will increase. Although the effect of high dose radiation exposure is known, the long-term effect of exposure to low doses is unclear. This study aims to investigate damage to the nail and skin on the thumbs of spine surgeons via occupational ionizing radiation exposure. Methods Forty male spine surgeons (group S) and 40 males of the same age group who were not exposed to radiation (controls; group C) were included. Using a scoring system, we evaluated the damage to the fingernail and skin of the bilateral thumb. Scoring was based on fingernail pigmentation (melanonychia), fingernail crack, and periungual dermatitis status. We investigated the number of examinations and operations under radiation exposure in the last 3 months. Results Group S had 17.83 (3-28) years of surgeon experience. In group S, the dominant side scored significantly higher than the non-dominant side; however, there was no dominant vs. non-dominant difference in group C. Only the dominant side had a significantly higher score in group S than in group C. In group S, surgeon experience and the score of the dominant side were significantly correlated; however, for the non-dominant side of group S and both thumbs of group C, no correlation was observed. The kappa coefficients for fingernail pigmentation, fingernail crack, and periungual dermatitis status were 0.458, 0.248, and 0.612, respectively. The average number of examinations and operations under radiation exposure was 11.89 ± 9.04 (0-30) and 26.34 ± 14.67 (1-63), respectively. Conclusions The dominant side in group S had a significantly higher score than the non-dominant side in group S and the dominant side in group C, suggesting the possibility of radiation damage to the dominant side in group S.
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Affiliation(s)
- Shunsuke Fujibayashi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Koichi Murata
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takayoshi Shimizu
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Bungo Otsuki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kazutaka Masamoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yu Shimizu
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Batra J, Aulakh S, Chopra D, Sarangal R, Puri S. Skin as a Mirror to Internal Malignancy: A Rare Co-presentation of Nail Bed Squamous Cell Carcinoma and Renal Cell Carcinoma. Indian Dermatol Online J 2021; 12:580-582. [PMID: 34430464 PMCID: PMC8354395 DOI: 10.4103/idoj.idoj_848_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/22/2020] [Accepted: 02/23/2021] [Indexed: 11/19/2022] Open
Abstract
Squamous cell carcinoma (SCC) of the nail bed is not encountered commonly although it is the most common primary malignancy at this site. In general, it has a low rate of spread, except for high risk types which carry a greater risk of spread. Screening for systemic tumours should be done in all cases especially in the elderly. We present the case of a 67 year old male who was otherwise healthy and presented with just nail discoloration associated with pain and occasional profuse bleeding with minor trauma which turned out to be SCC of nail bed on biopsy. Subsequently, he was screened for internal malignancies and was found to have clear cell Renal cell carcinoma of right kidney and a metastatic nodule in right lung. This presentation has not been previously described in literature.
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Affiliation(s)
- Jayati Batra
- Government Medical College Patiala, Punjab, India
| | | | | | | | - Sulabh Puri
- Government Medical College Patiala, Punjab, India
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Acuña Pinzon CL, Nieves Condoy JF, Zúñiga Vázquez LA, Chavez Perez G, Chavarría Chavira JL. Squamous Cell Carcinoma of the Nail, an Underdiagnosed and Underestimated Entity: A Series of Two Cases. Cureus 2021; 13:e14826. [PMID: 34094779 PMCID: PMC8172308 DOI: 10.7759/cureus.14826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The nail apparatus is a complex area with great functional and cosmetic importance. The appearance of tumors is rare, frequently misdiagnosed with delaying the diagnosis. A series of cases is presented, where squamous cell carcinoma of nail apparatus underwent resection and reconstructive surgery in a relatively short time from their diagnosis, with a good oncological, functional, and cosmetic result.
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Lim SS, Ohn J, Mun JH. Diagnosis of Onychomycosis: From Conventional Techniques and Dermoscopy to Artificial Intelligence. Front Med (Lausanne) 2021; 8:637216. [PMID: 33937282 PMCID: PMC8081953 DOI: 10.3389/fmed.2021.637216] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 03/19/2021] [Indexed: 12/17/2022] Open
Abstract
Onychomycosis is a common fungal nail infection. Accurate diagnosis is critical as onychomycosis is transmissible between humans and impacts patients' quality of life. Combining clinical examination with mycological testing ensures accurate diagnosis. Conventional diagnostic techniques, including potassium hydroxide testing, fungal culture and histopathology of nail clippings, detect fungal species within nails. New diagnostic tools have been developed recently which either improve detection of onychomycosis clinically, including dermoscopy, reflectance confocal microscopy and artificial intelligence, or mycologically, such as molecular assays. Dermoscopy is cost-effective and non-invasive, allowing clinicians to discern microscopic features of onychomycosis and fungal melanonychia. Reflectance confocal microscopy enables clinicians to observe bright filamentous septate hyphae at near histologic resolution by the bedside. Artificial intelligence may prompt patients to seek further assessment for nails that are suspicious for onychomycosis. This review evaluates the current landscape of diagnostic techniques for onychomycosis.
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Affiliation(s)
| | - Jungyoon Ohn
- Department of Dermatology, Seoul National University College of Medicine, Seoul, South Korea.,Institute of Human-Environment Interface Biology, Seoul National University, Seoul, South Korea
| | - Je-Ho Mun
- Department of Dermatology, Seoul National University College of Medicine, Seoul, South Korea.,Institute of Human-Environment Interface Biology, Seoul National University, Seoul, South Korea
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Dominguez-Cherit J. Subungual Invasive Squamous Cell Carcinoma with Doubtful Underlying Bone Invasion: A Treatment Proposal. Skin Appendage Disord 2020; 7:108-111. [PMID: 33796555 DOI: 10.1159/000511740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 09/20/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction Subungual squamous cell carcinoma (sSCC) is the most frequent malignant tumor of the nail unit. When suspecting sSCC, accurate diagnosis is supported by nail biopsy. Depth of invasion and histopathologic signs of human papillomavirus (HPV) infection are related to an unfavorable prognosis. In this case, it is necessary to rule out bone invasion by radiography or MRI, and in case of doubt, amputation is indicated. Case Presentation We present 2 cases of sSCC with a confirmatory biopsy of sSCC with HPV and invasion; in both cases, MRI was difficult to distinguish between bone invasion and bone marrow inflammation. Before amputating the distal phalanx, we decided to perform a bone biopsy during the excisional surgery. Neither case required amputation. Conclusion We propose that when an invasive sSCC is present and an MRI is doubtful of bone invasion, before amputating, a bone biopsy should be performed.
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Affiliation(s)
- Judith Dominguez-Cherit
- Department of Dermatology, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubiràn", Mexico City, Mexico
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Mazzilli S, Cosio T, Diluvio L, Vollono L, Gonzalez S, Di Prete M, Orlandi A, Bianchi L, Campione E. Dermoscopy and Reflectance Confocal Microscopy in the Diagnosis and Management of Nail Fold Squamous Cell Carcinoma. J Med Life 2020; 13:107-111. [PMID: 32341711 PMCID: PMC7175428 DOI: 10.25122/jml-2019-0129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The management and prognosis of squamous cell carcinoma largely depend on its invasiveness and grade of differentiation. Pigmented nail fold squamous cell carcinoma represents a therapeutic challenge, needing careful treatment to preserve nail function. Here, we report the use of dermoscopy and Reflectance Confocal Microscopy to monitor nail fold squamous cell carcinoma in situ and its response to treatment with topical imiquimod.
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Affiliation(s)
- Sara Mazzilli
- Dermatologic Unit, University of Rome Tor Vergata, Rome, Italy
| | - Terenzio Cosio
- Dermatologic Unit, University of Rome Tor Vergata, Rome, Italy
| | - Laura Diluvio
- Dermatologic Unit, University of Rome Tor Vergata, Rome, Italy
| | - Laura Vollono
- Dermatologic Unit, University of Rome Tor Vergata, Rome, Italy
| | - Salvador Gonzalez
- Department of Medicine and Medical Divisions, University of Alcalá, Madrid, Spain
| | - Monia Di Prete
- Anatomic Pathology Unit, University of Rome Tor Vergata, Rome, Italy
| | - Augusto Orlandi
- Anatomic Pathology Unit, University of Rome Tor Vergata, Rome, Italy
| | - Luca Bianchi
- Dermatologic Unit, University of Rome Tor Vergata, Rome, Italy
| | - Elena Campione
- Dermatologic Unit, University of Rome Tor Vergata, Rome, Italy
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