Fingernail Squamous Cell Carcinoma: A Scoping Review of Surgical Approaches and Clinical Decision Making

BACKGROUND: Squamous cell carcinoma of the fingernail unit (nSCC) is a rare malignancy frequently misdiagnosed as benign nail disease, resulting in delayed diagnosis and heterogeneous management. OBJECTIVE: To characterize surgical management patterns of nSCC and determine if imaging and other clinical factors influence the decision to perform digit preservation techniques versus amputation. MATERIALS AND METHODS: A scoping review of PubMed was performed to analyze the current literature from 2000 onward regarding surgical management of nSCC. Data on clinical presentation, tumor characteristics, imaging, treatment approach, and outcomes were extracted and synthesized descriptively. RESULTS: Eighty studies met inclusion criteria, predominantly case reports and small case series. NSCC commonly mimicked benign nail conditions, contributing to delayed diagnosis. Human papillomavirus-associated disease was described in recurrent, multifocal, and immunosuppressed cases. Imaging was reported in 50% of studies, most commonly plain radiography. Bone invasion, recurrent disease, and extensive local involvement were most frequently associated with amputation, whereas digit-sparing approaches, particularly Mohs micrographic surgery, were commonly used in localized disease without osseous involvement. CONCLUSION: Management of nSCC reflects a reproducible decision-making framework centered on disease extent, bone involvement, recurrence status, and preservation of function. Early recognition and timely biopsy may increase opportunities for digit-sparing treatment.