Clinicopathologic Features and Pre-diagnostic Spectrum of Nail Unit Squamous Cell Carcinoma: A 10-Patient Case Series
EADV SYMPOSIUM 2026, ATHENS, Athens, Yunanistan, 7 - 09 Mayıs 2026, ss.197-198, (Özet Bildiri)
- Yayın Türü: Bildiri / Özet Bildiri
- Basıldığı Şehir: Athens
- Basıldığı Ülke: Yunanistan
- Sayfa Sayıları: ss.197-198
- Ankara Üniversitesi Adresli: Evet
Özet
Nail unit squamous cell carcinoma (nSCC), including nSCC in
situ (Bowen disease), is the most common malignant tumor of the nail unit and
presents with a broad and often misleading clinical spectrum. Because these
lesions frequently mimic infections or benign subungual solitary and pigmentary
conditions, diagnosis is commonly delayed for years (1–4). Early recognition
requires a high index of suspicion, awareness of warning clinical features, and
timely nail unit biopsy using an appropriate technique followed by careful
dermatopathological evaluation. The aim of this study was to evaluate the
clinical and epidemiological characteristics of patients with subungual
squamous cell carcinoma, focusing on clinical presentation, diagnostic challenges,
diagnostic work-up, and treatment outcomes. A retrospective evaluation was
conducted on 10 patients with histopathologically confirmed nSCC or nSCC in
situ diagnosed between 2022 and 2025. Epidemiologic characteristics and risk
factors, clinical features, clinical prediagnoses, final dermatopathological
diagnosis (in situ or invasive), HPV status (when molecular testing was
available), and planned treatment modalities were analyzed. A total of 10
patients were included (6 males, 4 females), with a mean age of 59.5 ± 14.7
years (24–79 years). Lesions were located on the hand in 60% (6/10) and on the
foot in 40% (4/10), with predominant involvement of the first digit/thumb in
70% (7/10). The most common presenting findings were subungual hyperkeratosis
(50%, 5/10) and discharge (50%, 5/10), followed by ulceration (30%, 3/10), nail
color changes (30%, 3/10), nail dystrophy (30%, 3/10), and subungual mass
formation (30%, 3/10) (Table 1). Verrucous lesions were observed in 20% (2/10).
A history of trauma was present in one patient. The mean interval between
lesion onset and definitive diagnosis was 30.5 months (4–96 months). Six
patients had previously received treatment for presumed onychomycosis, and
three had undergone prior nail avulsion. Histopathologically, 20% of cases were
classified as nSCC in situ and 80% as invasive nSCC. High-risk HPV was detected
in 33.3% (2/6) of tested patients. Therapeutic wide local excision was
performed in 60%, while bone invasion– associated amputation was performed in
30%. nSCC predominantly affects individuals over 50 years of age, shows male
predominance, and most frequently involves the first digit (1,2). Consistent
with the literature, the mean age in our cohort was 59.5 years, 60% of patients
were male, and first-digit involvement was observed in 70%. All cases presented
with single-nail involvement, and the most common findings were subungual
hyperkeratosis (%50), discharge (%50), and nail dystrophy (%30), reflecting the
nonspecific clinical presentation of nSCC (1,3). Nonspecific features
contribute to diagnostic delays of up to 5–7 years in previous reports (1,3);
in our cohort, the mean delay was 30.5 months. While amputation rates of
approximately 20% have been reported (2), amputation was required in 30% of our
patients, emphasizing the importance of early diagnosis to prevent advanced
disease and limb-sacrificing surgery. Although high-risk HPV has been reported
in 60–80% of cases (4), positivity was detected in only 30% of our series,
indicating that nSCC is not exclusively HPV-related. The primary therapeutic
goal is complete tumor excision with histologically clear margins; accordingly,
wide local excision with margins exceeding 4–6 mm was performed in 60% of patients,
in line with current recommendations (2,5).