Medical Must-See: Cancer of the nail bed

By Alice Klein

A woman who was mistakenly diagnosed with paronychia has been found to have squamous cell carcinoma of the nail bed.

The 61-year-old presented to a dermatology clinic with a three-year history of nail deformity and an indolent ulcer on her left thumb.

She told doctors that she had been treated several times with incision and antibiotic therapy after an initial diagnosis of paronychia, but the lesion had not resolved.

Physical examination revealed an irregular, pigmented, ulcerated lesion on the nail bed and a yellowish broken nail. There was no clear history of trauma or a previous wart.

After the results of a mycological evaluation came back negative, an incisional biopsy was performed.

Histopathological examination of a biopsy specimen revealed moderately differentiated SCC.

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Doctors then performed chest radiography and whole-body technetium-99m scans to detect possible metastases but none were found.

According to the case report author, Dr Amir Feily, the lesion was then surgically excised.

SCC of the nail bed is rare and often looks like other benign conditions such as psoriasis, verruca vulgaris, paronychia, and onychomycosis, he wrote in the New England Journal of Medicine.

"Therefore, its diagnosis can easily be missed or delayed," explained Dr Feily, who is a dermatologist at the Skin and Stem Cell Research Centre at Tehran University of Medical Sciences in Iran.

More information: New England Journal of Medicine 2015; 373:2357.

This article first appeared on Australian Doctor on the 10th of December,2015

A woman who was mistakenly diagnosed with paronychia has been found to have squamous cell carcinoma of...

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