Introduction:

Subungual Squamous Cell Carcinoma (SCC) is a rare form of skin cancer that arises beneath the nail bed. Due to its location and often subtle presentation, it can be easily misdiagnosed as a fungal infection, trauma, or other benign nail disorders. This article provides an in-depth look at subungual SCC, highlighting its etiology, clinical manifestations, diagnostic pathways, therapeutic measures, and prognosis.

Causes and Risk Factors of Subungual SCC:

• Chronic Sun Exposure: Ultraviolet (UV) radiation is a known risk factor for SCC, though its direct link to subungual SCC is less clear.
• HPV Infection: Certain strains of the Human Papillomavirus have been associated with subungual SCC.
• Chronic Inflammation or Injury: Persistent trauma or inflammation to the nail bed can increase the risk.
• Immunosuppression: Individuals with weakened immune systems, whether due to conditions like HIV or medications, may be at a higher risk.

Symptoms and Clinical Presentation of Subungual SCC:

• Nail Discoloration: A brown, black, or red streak under the nail.
• Nail Deformity: Thickening, cracking, or distortion of the nail plate.
• Ulceration or Bleeding: Spontaneous bleeding or formation of an ulcer in the nail bed.
• Pain or Tenderness: Especially if there's no known trauma.
• Loss of the Nail: In advanced cases, the nail might fall off or fail to grow back.

Diagnostic Procedures for Subungual SCC:

• Clinical Examination: A detailed inspection of the nail and surrounding tissue.
• Biopsy: Essential for diagnosis, a tissue sample from the affected area is examined histologically to identify cancerous cells.
• Imaging: X-rays or MRI might be used to assess the extent of the disease, especially if bone invasion is suspected.

Treatment Modalities for Subungual SCC:

• Surgical Excision: The primary treatment involves surgically removing the tumor along with a margin of healthy tissue.
• Mohs Surgery: A specialized surgical technique where thin layers of cancer-containing skin are progressively removed and examined until only cancer-free tissue remains.
• Radiation Therapy: Used in cases where surgery isn't feasible or as an adjunct to surgery.
• Topical Chemotherapy: Application of chemotherapeutic agents directly to the lesion.
• Lymph Node Evaluation: To determine if the SCC has spread to nearby lymph nodes.

Prognosis and Aftercare:

The prognosis for subungual SCC largely depends on the stage at diagnosis and whether there's bone involvement. Early detection often leads to better outcomes. Regular follow-ups post-treatment are essential to monitor for recurrence and manage potential complications. Patients are also advised to perform self-examinations and protect the area from further trauma.

Conclusion:

Subungual Squamous Cell Carcinoma, while rare, emphasizes the importance of a thorough examination of any persistent nail abnormalities. Awareness, early detection, and prompt intervention are key to effectively managing this form of skin cancer.

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