Squamous cell carcinoma of the nail bed: A case report

BACKGROUND: Squamous cell carcinoma (SCC) of the nail bed is a poorly reported malignant subungual tumor. Because it presents with nonspecific symptoms and signs, it is frequently misdiagnosed by dermatologists or surgeons. A delay in diagnosis and/or wrong treatment might increase the possibility of disease progression. Thus, new perspectives are needed to assist dermatologists and surgeons with diagnosing and treating SCC. This rare case presented with a 2-year delay in the diagnosis of SCC teaches a valuable lesson. CASE SUMMARY: A 62-year-old female presented with a non-healing subungual growth in the nail bed of the right middle finger for 2 years. The lesion was first medicated with iodine by the patient herself without any relief. Twenty months later, a dermatologist diagnosed the lesion as paronychia and treated it with nail avulsions repeatedly with no obvious alleviation. A lesionectomy confirmed the lesion was SCC. An extended excision of the tumor with amputation of the distal interphalangeal joint was subsequently performed. A biopsy of sentinel lymph nodes was negative. Due to the result of preoperative positron emission tomography-computed tomography scanning, sweeping of axillary lymph nodes was considered dispensable and was skipped. At the 2-year follow-up, the patient showed a quick recovery and no sign of recurrence. CONCLUSION: Our successful diagnosis and treatment of the case highlights the need for additional attention to long-standing non-healing lesions of the nail bed and the necessity for discreet evaluation and customization of surgical interventions.