Metastasis to a phalanx simulating infection in a finger

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...…”

“…In some of the patients, a recent prior history of trauma to the digit further supported a diagnosis of infection. 3,8,9,28,52,106,136 However, other features that might suggest a noninfectious diagnosis include a lack of response to treatment by surgical drainage 3,9,15,16,26,28,35,62,73,137 and increased severity of the clinical signs and symptoms-out of proportion with the degree of lesional pain. 12,136 Prior studies have evaluated the relationship between the site of origin of the primary tumor and the incidence of metastases to either the distal upper extremity or the distal lower extremity.…”

“…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.…”

“…[145][146][147][148] The amount of time following the presentation or diagnosis of a subungual metastasis and the death of that patient was evaluated by reviewing the case reports of 31 patients with subungual metastases. 1-3, 6-10,12,15,16,19,31,32,36,37,44,46,50-52,58,60,63,70 More than 80% of the patients (22 of 27 individuals) 1,3,[6][7][8][9][10]12,15,19,31,32,36,44,46,52,58,60,63,70 had died (either as a direct or indirect consequence of their tumor) within less than 6 months after their subungual metastasis had been detected. Survival ranged from 7 to 14 months in four of the remaining five patients; 3,50,51,70 the last patient survived for 3.5 years following the diagnosis of his subungual metastasis.…”