Subungual Basal Cell Carcinoma: A Rare Nail Tumor with a Challenging Diagnosis

Abstract

Subungual basal cell carcinoma (BCC) is a rare disorder associated with many factors, including contact with some topical and oral substances. A differential diagnosis and an early approach are important to minimize the functional damage of the limbs affected by this type of tumor. We report a case of subungual BCC in a 70-year-old woman that was managed by surgical excision. The patient’s medical history included the previous use of arsenic. We emphasize the contribution of an early diagnosis to achieve better treatment results in this instance.

“Basal cell carcinoma of the hand: A systematic review and meta-analysis of incidence of recurrence”

“…The following reasons prompted the exclusion of 59 articles: improper methods (systematic review, review article, and letter to editor), n = 12, no outcome of interest ( n = 19), the full text could not be located ( n = 14), the specific location of BCC was not stated ( n = 12), included non-hand BCC patients ( n = 2). Thirty-five studies were case reports, 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 2 studies were case series, 53 , 54 1 study was a prospective cohort analysis, 55 and the remaining studies were retrospective cohort studies. Two studies were published in Australia, 27 , 40 6 studies were published in Asia, 22 , 23 , 27 , 32 , 47 , 49 17 studies were published in Europe, 8 , 19 , 25 , 34 , 35 , 38 .…”

“…2017 54 CS Turkey 03-Jul 3/0 56 NA Level V Pollo et al. 2019 31 CR Brazil 01-Jan 0/1 70 NA level V Rallis et al. 2010 32 CR India 01-Jan 0/1 63 NA Level IV Riml et al.…”

“…Nail involvement was reported in 41 studies, of which the nails were involved among the patients in 16 studies (39%). 20 , 21 , 22 , 28 , 31 , 33 , 35 , 36 , 38 , 42 , 43 , 45 , 46 , 48 , 49 , 50 Hand laterality was reported in 37 studies, 6 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 60 and the lesions were approximately equally distributed (33 and 31 lesions in the right and left hands, respectively). Metastasis was positive in a case report, 23 and bone involvement was positive in another case report.…”

“…2017 54 Phalanges Rash and swelling No NA Pollo et al. 2019 31 Nail Friable lesion with periungual erythema and onychodystrophy Yes infiltrative Rallis et al. 2010 32 Second interdigital space Fleshy No Ulcerated Riml et al.…”

“… 28 In these studies, 34 out of 2051 patients experienced fingernail involvement with variable morphological features including ulcerative, longitudinal plaque, or onychodystrophy. 20 , 21 , 22 , 28 , 31 , 33 , 35 , 36 , 38 , 42 , 43 , 45 , 46 , 48 , 49 , 50 Many of the reported studies found initial difficulties in obtaining the correct diagnosis of BCC due to the wide variety of lesions and malignancies that can arise from the hand with similar morphological features, including glomus tumor, 29 melanoma, 50 and actinic keratosis. 20 These findings highlight the importance of performing biopsies in cases with uncertain diagnoses or failure of treatments to detect misdiagnosis.…”