A Retrospective Study of Nail Squamous Cell Carcinoma at 2 Institutions

BACKGROUND Squamous cell carcinoma (SCC) of the nail is infrequently reported in the medical literature and its causes are poorly understood. Studies have shown strong associations with immunosuppression, tobacco use, toxin/radiation exposure, and trauma. Common treatments include Mohs surgery and digital amputation. OBJECTIVE Review a series of nail SCCs treated at 2 institutions. Outcomes evaluated included rates of recurrence and disease progression/metastasis after treatment. MATERIALS AND METHODS A retrospective review of patients treated between 2005 and 2008. Medical record review and phone call follow-up using a standardized questionnaire were used. RESULTS Forty-two tumors were identified in 34 patients. Twenty-seven patients were male (79% CI, 62%-91%) and most tumors were located on the fingernails (39/42; 91% CI, 81%-99%). Twenty-four of 39 tumors (62% CI, 45%-77%) were on the nondominant hand. The middle third finger was the most frequent digit affected (16/42). Common symptoms reported were nail dystrophy (31/42; 74% CI, 58%-86%), followed by onycholysis (22/42; 52% CI, 36%-68%). Most tumors (35/42; 83% CI, 69%-93%) were treated with Mohs surgery. CONCLUSION Nail SCC is found nearly exclusively in adults and predominantly in men. There are multiple effective treatment possibilities including Mohs surgery, distal digital amputation, and early evidence suggesting radiotherapy.