Background Nail squamous cell carcinoma (NSCC) is the most common nail malignancy, yet it is underrecognized because of its variable presentation.Objective Characterize demographic and clinical characteristics associated with in situ (NSCCis) and invasive (iNSCC) NSCC and evaluate treatment outcomes in a multinational cohort.Methods Two-hundred-sixty-nine NSCCs (261 patients) were retrospectively reviewed. NSCCis and iNSCC characteristics were compared using t-tests/chi-square and multinomial logistic regression.Results NSCC mainly affected the right index and middle fingers and bilateral thumbs (62%), predominantly in men (72.4%) in their sixth decade. Koilocytosis, used to determine HPV status, was detected in 32.2% of tumors (15 PCR-confirmed), and this was more common in NSCCis (P=0.015). Subungual ooze independently predicted iNSCC (OR=3.98;95%CI=1.19-13.2;P=0.025), while pain (P=0.022) and nail plate loss (P=0.004) were associated with iNSCC on univariate analysis. Mohs micrographic surgery was the most common treatment (39.5%). Overall recurrence was 9.7%, with no difference among treatments (P>0.05).Limitations Retrospective design and histopathology-based HPV status.Conclusions NSCC presents as a periungual papule/plaque with horizontal growth and nail plate loss or oozing subungual ulcerating tumor, dermally invasive. Periungual NSCC is associated with HPV, often sexually transmitted. HPV-related cases are typically NSCCis. Digit-sparing surgery is first-line treatment, with comparable efficacy across modalities.
Lipner et al. (Thu,) studied this question.
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