Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 6, 2019; 7(21): 3590-3594
Published online Nov 6, 2019. doi: 10.12998/wjcc.v7.i21.3590
Squamous cell carcinoma of the nail bed: A case report
Peng-Fei Li, Ning Zhu, Hui Lu
Peng-Fei Li, Department of Plastic and Aesthetic Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310000, Zhejiang Province, China
Ning Zhu, Department of Ophthalmology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310000, Zhejiang Province, China
Hui Lu, Department of Orthopedics, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310000, Zhejiang Province, China
Author contributions: Li PF drafted the manuscript and participated in the analysis of the study; Lu H helped carry out surgical intervention and care for the patient; Zhu N and Lu H participated in the design and coordination of the study, performed the analysis, and helped revise the manuscript; All authors read and approved the final manuscript.
Supported by the National Natural Science Foundation of China, No. 81702135; Zhejiang Medical Association Clinical Scientific Research Program, No. 2013ZYC-A19 and 2015ZYC-A12; Zhejiang Medicine and Hygiene Research Program, No. 2016KYB101 and 2015KYA100; Zhejiang Traditional Chinese Medicine Research Program, No. 2016ZA124 and 2017ZB057.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Hui Lu, MD, Attending Doctor, Department of Orthopedics, The First Affiliated Hospital, School of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou, Zhejiang Province 310003, China. huilu@zju.edu.cn
Telephone: +86-571-87236121
Received: May 31, 2019
Peer-review started: June 4, 2019
First decision: August 1, 2019
Revised: August 24, 2019
Accepted: September 11, 2019
Article in press: September 11, 2019
Published online: November 6, 2019
Abstract
BACKGROUND

Squamous cell carcinoma (SCC) of the nail bed is a poorly reported malignant subungual tumor. Because it presents with nonspecific symptoms and signs, it is frequently misdiagnosed by dermatologists or surgeons. A delay in diagnosis and/or wrong treatment might increase the possibility of disease progression. Thus, new perspectives are needed to assist dermatologists and surgeons with diagnosing and treating SCC. This rare case presented with a 2-year delay in the diagnosis of SCC teaches a valuable lesson.

CASE SUMMARY

A 62-year-old female presented with a non-healing subungual growth in the nail bed of the right middle finger for 2 years. The lesion was first medicated with iodine by the patient herself without any relief. Twenty months later, a dermatologist diagnosed the lesion as paronychia and treated it with nail avulsions repeatedly with no obvious alleviation. A lesionectomy confirmed the lesion was SCC. An extended excision of the tumor with amputation of the distal interphalangeal joint was subsequently performed. A biopsy of sentinel lymph nodes was negative. Due to the result of preoperative positron emission tomography-computed tomography scanning, sweeping of axillary lymph nodes was considered dispensable and was skipped. At the 2-year follow-up, the patient showed a quick recovery and no sign of recurrence.

CONCLUSION

Our successful diagnosis and treatment of the case highlights the need for additional attention to long-standing non-healing lesions of the nail bed and the necessity for discreet evaluation and customization of surgical interventions.

Keywords: Squamous cell carcinoma, Nail bed lesion, Customized treatment, Malignant subungual tumor, Case report

Core tip: Squamous cell carcinoma of the nail bed is a malignant subungual tumor that is poorly reported. Considering its nonspecific symptoms and signs, it is usually misdiagnosed by dermatologists or surgeons. We present herein, a rare case of squamous cell carcinoma in the nail bed in which the diagnosis was delayed by belated medical help and misdiagnosis. Our successful diagnosis and treatment of the case highlights the need for additional attention to long-standing non-healing lesions of the nail bed and the necessity for discreet evaluation and customization of surgical interventions.