Subungual, squamous cell carcinoma: Report of 2 cases

Subungual squamous cell carcinoma (SCC) is a rare malignant tumor with an i ndolent course. Its etiology is unknown. It often involves the distal phala nx of the thumb or the index finger, and often presents as a chronic ulcer that is commonly misdiagnosed as chronic paronychia, pyogenic granuloma or verruca vulgaris. Approximately 150 cases of subungual SCC, including one i n a Taiwanese patient, have been reported. Here, we report two cases of subungual SCC presenting as a chronic ulcer of the nail bed refractory to antibiotic treatment. One case involved the rig ht thumb, while the other involved the right index finger. Radiographs of both cases shelved an osteolytic bone lesion involving the d istal phalanx. Excision biopsy revealed SCC in both cases. Both patients re ceived amputation of the involved distal phalanx and shelved no signs of re occurrence during 5 years of follow-up. These findings suggest that all rec alcitrant ulcers of the nail bed should be biopsied to facilitate early dia gnosis and treatment of subungual SCC.