Non-pigmented Subungual Malignancies – Crux Chirurgiae Minoris


Authors: M. Stašek;  P. Špička;  P. Zapletal *;  D. Štefanička;  P. Šišma
Authors‘ workplace: Chirurgické oddělení, Středomoravská nemocniční, a. s., Odštěpný závod Nemocnice Prostějov, přednosta prim. MUDr. Petr Vojáček, CSc. ;  Chirurgické oddělení, Středomoravská nemocniční, a. s., Odštěpný závod Nemocnice Prostějov, přednosta Oddělení patologie, Středomoravská nemocniční, a. s., Odštěpný závod Nemocnice Prostějov, přednosta: Chirurgické oddělení, Středomoravská nemocniční, a. *
Published in: Rozhl. Chir., 2009, roč. 88, č. 3, s. 147-150.
Category: Monothematic special - Original

Overview

Background:
Incidence of amelanotic subungual malignancies is small, but they are not extremely rare and are often omitted in the diagnostic algorithm of subungual lesions. Methods: Retrospective analysis of four amelanotic subungual tumours – 2 subungual melanomas and 2 spinocellular carcinomas. Diagnosis was made by surgeon and pathologist.

Results:
We have observed frequent traumatic history, patients’ symptomatology underrating, inconspicuous clinical manifestation with unusual macroscopic morphological features and a risk of diagnostic delay.

Conclusion:
It is necessary to consider possibility of subungual malignancies in diagnostic algorithm of nail unit pathologies. Early diagnosis enables the reduction of amputation rate. We recommend excision biopsy with low indication threshold. There is fatal risk of delayed diagnosis especially in subungual melanoma cases, and mostly mutilation risk in spinocellular carcinoma cases.

Key words:
subungual squamous cell carcinoma – subungual melanoma – amelanotic melanoma – malignancy of the nail unit


Sources

l. Krajsová, I. Melanom. Klasifikace, diagnostika, terapie, prevence. Praha, Maxdorf, 2006.

2. Kato, T., Setake, T., et al. Epidemiology and prognosis of subungual melanoma in 34 Japanese patients. Br. J. Dermatol., 1996, 134, č. 3, s. 383–387.

3. Phan, A., et al. Acral lentiginous melanoma: a clinicoprognostic study of 126 cases. Br. J. Dermatol., 2006, 155, č. 3, s. 561–569.

4. Banfield, C. C., et al. The incidence and prognosis of nail apparatus melanoma. A retro specti ve study of 105 patients in four English regions. Br. J. Dermatol., 1998, 139, s. 276–279.

5. Levit, E. K., Kagen, M. H., Scher, R. K., et al. The ABC rule for clinical detection of subungual melanoma. J. Am. Acad. Dermatol., 2000, 42, s. 269–274.

6. Kaiser, J. F. Squamous cell carcinoma in situ mimicking subungual verruca vulgaris – Bowen‘s disease. J. Fam. Pract.,

http://findarticles.eom/p/articles/mi_m0689/is_n4_v39/ai_1584_2587.

7. Dalle, S., Depape, L., Phan, A., et al. Squamous cell carcinoma of the nail apparatus: clinicopathological study of 35 cases. Br. J. Dermatol., 2007, 156, č. 5, s. 871–874.

8. Dominguez-Cherit, J., Garcia, C., et al. Pseudo-fibrokeratoma: an unusual presentation of subungual squamous cell carcinoma in a young girl. Dermatos. Surg., 2003, 29, č. 7, s. 788–789.

9. Betti, R., Vergani, E., et al. Subungual squamous cell carcinoma mimicking chronic paronychia. Eur. J. Dermatol., 2000, 10, č. 2, s. 149–150.

10. Phan, A., et al. Acral lentiginous melanoma: a clinicoprognostic study of 126 cases. Br. J. Dermatol., 2006, 155, č. 3, s. 561–569.

11. Wong, T. C., Ip, F. K., Wu, W. C. Squamous cell carcinoma of the nail bed: Three case reports. J. Orthop. Surg., 2004, 12, č. 2, s. 248–252.

12. Heaton, K. M., el-Naggar, A., et al. Surgical management and prognostic factors in patients with subungual melanoma. Ann. Surg., 1994, 219, č. 2, s. 197–204.

13. Pizzichetta, M. A., Talamini, R., Stanganelli, I., et al. Amelanotic/hypomelanotic melanoma: clinical and dermoscopic features. Br. J. Dermatol., 2004, 150, č. 6, s. 1117–1124.

14. Bakotic, B. W. Expert insights on diagnosing pigmented skin lesions. Podiatry Today. 2005, 17, č. 4, s. 76–82.

15. Chih-hsun Yang, Jiun-ting Yeh, et al. Regressed subungual melanoma simulating cellular blue nevus. Dermatos. Surg., 2006, 32, č. 4, s. 577–581

16. Thai, K. E., et al. Nail apparatus melanoma. Austral. J. Dermatol., 2001, 42, s. 71–81.

17. Mooney, M., Parry, E. Mohs micrographic surgery. Dostupný na: www.emedicine.com/derm/TOPIC542.HTM

18. Peterson, S. R., Lakton, E. G., Joseph, A. K. Squamous cell carcinoma of the nail unit with evidence of bony involvement: a multidisciplinary approach to resection and reconstruction. Dermatos. Surg., 2004, 30, č. 2, s. 218–221.

19. Murphy, G. F. Dermatopathology. W. B. Saunders, 1995.

20. Pizinger, K. Kožní pigmentové projevy. Praha, Grada, 2003.

Labels
Surgery Orthopaedics Trauma surgery
Login
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account