Subungual Squamous Cell Carcinoma of the Toe: Report on Three Cases

Abstract

Unlike Bowen's disease and SCC of the fingernails, a causative role of HPV infection in the development of in situ and invasive subungual SCC of the toe seems unlikely.

Sonography of the Nail

“…18.54 ). Subungual involvement because of SCC occurs most frequently on the fi ngernails, and has rarely been reported on the toes [ 85 ] . Detection of in situ SCC (Bowen's disease) in ungual locations is limited by the resolution of sonography that can currently be obtained.…”

Subungual Squamous Cell Carcinoma of the Toe: Working Toward a Standardized Therapeutic Approach

“…But as with other forms of cutaneous SCC, metastasis does occur with subungual disease. [16][17][18] Although the etiology of subungual SCC is not well characterized, lesions on the finger have been associated with human papillomavirus (HPV) infection. 19,20 Other possible causes include trauma, chronic inflammation, and radiation exposure.…”

Caso para diagnóstico

“…Differential diagnosis depends on the presentation and includes chronic paronychia, piogenic granuloma, verruca vulgaris, onicomycosis, psoriasis, subungueal exostosis and melanoma. [1][2][3] Other diagnosis of difficult differentiation are keratoacanthoma, which may have similar clinical, histological and radiological findings, and metastatic SCCs, which are extremely rare and occur following lung and esophageal cancer. [1][2][3] Subungueal SCC etiology is not known, however, there are numerous factors implicated in the pathophysiology of the disease, such as trauma, chronic infection, immunosuppression, exposure to arsenic, coaltar or radiation, genetic disorders such as congenital dyskeratosis and congenital epidermolysis bullosa.…”

“…1,2 The treatment of choice for initial lesions, with no bone affection, is Mohs' micrographical surgery. 4 In case there is radiological evidence of bone affection, phalangis distalis or finger amputation is indicated.…”

“…4 In case there is radiological evidence of bone affection, phalangis distalis or finger amputation is indicated. 2,4 Other described treatments are photodynamic therapy and carbon dioxide laser for in situ tumors, Bowen disease-like, and radiation therapy, specially in case of non-resectable tumors.…”