Nail Cancer: Review of the Two Main Types of an Underestimated Disease

Abstract

Neoplastic lesions (benign or malignant) in the nail region are rare when compared to lesions in the rest of the skin. Despite advances in diagnostic modalities, their diagnosis is frequently delayed or overlooked for days, months, or even years when they are misrecognized or when their approach is not appropriate. Undoubtedly, malignant tumors are the most important lesions since an inopportune diagnosis or treatment can drastically change the patient's prognosis.A review of all the scientific evidence on the two main malignant neoplasms of the nail apparatus (melanoma and squamous cell carcinoma) was carried out using the PubMed search engine from 2003 to 2022, in order to expose the appropriate diagnostic approach and treatment of these nail lesions to avoid delays that obscure the prognosis of patients. This review does not include reconstruction modalities after lesion resection, but the emphasis is placed on the great functional impact they produce. Surgical treatment in the early stages is the most important when talking about prognosis and emphasizing it; systemic oncological management of advanced stages is not so deep.

Nails as Dynamic, Not Static, Entities—Rethinking the Approach to Nail Disorders

“…What ensues is a siloed approach to nail disorders that is not grounded in a clear understanding of the pathophysiology of nail disease. This is borne out in the literature reporting variable practice strategies for onychomycosis, delayed diagnoses of malignant nail neoplasms (eg, squamous cell carcinoma, melanoma), and increasing antifungal resistance, speculated to result, in part, from inappropriate use of antifungals for nail disease …”

“…What ensues is a siloed approach to nail disorders that is not grounded in a clear understanding of the pathophysiology of nail disease. This is borne out in the literature reporting variable practice strategies for onychomycosis, 3 delayed diagnoses of malignant nail neoplasms (eg, squamous cell carcinoma, melanoma), 4 and increasing antifungal resistance, speculated to result, in part, from inappropriate use of antifungals for nail disease. 5 Furthermore, many nail disorders may have ineffective (eg, high rates of recurrent fungal nail disease) or cost-prohibitive (eg, prescription lacquers, biologics for nail psoriasis) management strategies, which can lead to conscious or unconscious bias among providers in how they frame and engage with patients about treatment.…”