Verrucous Carcinoma of the Nail Bed

Abstract

Verrucous carcinoma is a rare, highly keratinizing variant of squamous cell carcinoma of the skin or mucosae characterized by a local aggressiveness but a low potential for metastasis. The plantar form is also known as epithelioma cuniculatum. Fingers and toes are rarely affected, and tumors of the nail bed are exceptional. Clinically, the lesion presents like a wart and is then often misdiagnosed. Treatment of choice is wide surgical excision. A case of verrucous carcinoma of the nail apparatus is presented, and diagnosis is discussed.

Squamous cell carcinoma arising in a psoriatic nail bed: case report with discussion of diagnostic difficulties and therapeutic options

“…SUKA paradoxically shows greater bone erosion than either VC or SCC, 2,3 , 22 perhaps by virtue of its more rapid growth (weeks to months), beneath a constraining nail plate, rather than an inherent biological aggressiveness; 12,23 (other subungual tumours, e.g. glomus tumour and epidermal inclusion cysts, can cause similarly benign bony erosion) 24 .…”

“…With regard to surgery, amputation of the involved distal phalanx is the generally preferred option for SCC; 1 although two of Shapiro and Baraf's seven cases did not undergo amputation, no long‐term follow‐up was available on them 1 . For subungual VC, distal phalanx amputation is the definitive procedure, particularly for extensive or recurrent tumours 2,3 . Moh's surgery has been proposed for subungual VC and may be a very good way of minimizing tissue loss 2,34 .…”

“…Squamous cell carcinoma (SCC) and verrucous carcinoma (VC) have been described as arising from the nail bed, but only rarely, 1–3 and no association with psoriasis is documented with either. The tumour we describe arose beneath a thickened psoriatic nail plate, leading to delay in clinical detection and particular difficulties in histological diagnosis and treatment.…”

Mohs micrographic surgery for nail unit tumours: an update and a critical review of the literature

“…Carcinoma cuniculatum (CC), also known as verrucous carcinoma, is a rare neoplasm of the NU displaying high keratinization with local aggressivity. It is considered a variant of SCC . Tosti et al .…”

Ungual Horn

“…These seven cases presented with hyperkeratotic verrucous papules and plaques with variable nail plate destruction, but none presented as an ungual horn. Among these cases, three were treated with excision [3][4][5] (of which one recurred and was then treated with amputation) [5], two were treated with amputation as primary treatment [6,7], one was treated with Mohs surgery [8], and one was treated with intra-arterial methotrexate [9]. Follow-up varied from several months to five years.…”