Isolated Secondary Deposit in a Terminal Phalanx in a Case of Squamous-Cell Carcinoma of the Lung

Metastatic Tumors to the Nail Unit: Subungual Metastases

“…105 In contrast to cancer patients with nonsubungual cutaneous metastases, it is not uncommon for a metastatic subungual tumor to be the first sign of an unsuspected cancer (and thereby prompting the subsequent discovery of the primary visceral malignancy) in oncology patients whose skin metastases are located subungually. 52 Review of the temporal relationship between the onset of symptoms or the appearance of the subungual metastasis and the diagnosis of the visceral malignancy in 50 patients with subungual metastases [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16]19,[30][31][32][33][34][35][36][37][38][42][43][44]46,47,49,52,[54][55][56][58][59][60]63,66,[68][69][70][71] showed that the metas...…”

“…Subungual metastases typically present as painful lesions of the distal digit. [1][2][3][6][7][8]12,13,15,16,31,[35][36][37]52,58,63,71 Less frequent presenting symptoms of subungual metastases include lesions that are either bleeding, 32,35,51 perceived as hot (when evaluated by the clinician), 3,32 fluctuant, 2,15,19,37 and/or pulsatile. 12,32 The most common appearance of the lesion is either as an erythematous enlargement or swelling of the distal digit or a red to violacious nodule that distorts either the nail plate, or the soft tissue of the distal digit, or both ( Table 3).…”

“…The distribution of subungual tumors in 51 patients with subungual metastases is summarized in Table 6. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16]18,19,[30][31][32][33][34][35][36][37][38][42][43][44]46,47,[49][50][51][52][54][55][56][58][59][60]63,66,[68][69][70][71] More than 90% (47 individuals) of patients with subungual metastases had lesions involving one or more digits of the hands. In 38 patients there was metastatic cancer to the subungual area of either a single finger or multiple fingers;…”

“…35,58,70 The seven patients with subungual metastases to the digits of the feet 16,35,38,52,58,70 include four patients whose metastases involved only the feet 16,38,52 and three patients whose metastases involved both the hands and feet. 35,58,70 54 patients with subungual metastases, 1-16,19,30-38,42-44, 46,47,49,52,54-56,58-60,63,66,68-71,129 92% (34 of 37 individuals) [1][2][3][4][5][6][7][8][9][12][13][14][15][16][30][31][32]35,36,38,47,49,51,52,56,60,71,129 of these patients either initially presented with or subsequently developed metastatic lesions of the distal phalanx that were detectable on roentgenograms of the respective digit; radiologic studies of the digits were not discussed in the reports of 17 patients. 1,10,…”

“…37,50,52 Surgical intervention has included nail avulsion and curettage of the tumor, 52 excision of the tumor, 58,63 and amputation of the digit containing the tumor. 2,3,6,7,9,16,32,35,51,56,60 Radiotherapy has also been administered to the bony metastasis of the distal phalanx and/ or the metastatic subungual tumor lesion. 3,19,36,50,58,63 The prognosis for patients in whom the diagnosis of a subungual metastasis has been confirmed is poor.…”