A Retrospective Study of Nail Squamous Cell Carcinoma at 2 Institutions.

ABSTRACT

BACKGROUND: Squamous cell carcinoma (SCC) of the nail is infrequently reported in the medical literature and its causes are poorly understood. Studies have shown strong associations with immunosuppression, tobacco use, toxin/radiation exposure, and trauma. Common treatments include Mohs surgery and digital amputation. OBJECTIVE: Review a series of nail SCCs treated at 2 institutions. Outcomes evaluated included rates of recurrence and disease progression/metastasis after treatment. MATERIALS AND METHODS: A retrospective review of patients treated between 2005 and 2008. Medical record review and phone call follow-up using a standardized questionnaire were used. RESULTS: Forty-two tumors were identified in 34 patients. Twenty-seven patients were male (79% CI, 62%-91%) and most tumors were located on the fingernails (39/42; 91% CI, 81%-99%). Twenty-four of 39 tumors (62% CI, 45%-77%) were on the nondominant hand. The middle third finger was the most frequent digit affected (16/42). Common symptoms reported were nail dystrophy (31/42; 74% CI, 58%-86%), followed by onycholysis (22/42; 52% CI, 36%-68%). Most tumors (35/42; 83% CI, 69%-93%) were treated with Mohs surgery. CONCLUSION: Nail SCC is found nearly exclusively in adults and predominantly in men. There are multiple effective treatment possibilities including Mohs surgery, distal digital amputation, and early evidence suggesting radiotherapy.