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Chang MJ, Schwartz Kahn M, Khachemoune A. Squamous cell carcinoma of the nail in patients with Fitzpatrick phototypes IV-VI: a systematic review. Int J Dermatol 2024. [PMID: 38736165 DOI: 10.1111/ijd.17237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 04/17/2024] [Accepted: 04/24/2024] [Indexed: 05/14/2024]
Abstract
Squamous cell carcinoma of the nail unit (nSCC) is a rare malignant tumor of the hand and nail. Although skin cancer rarely affects individuals with phototypes IV-VI, its occurrence in these groups is often associated with greater morbidity and mortality. This study aims to characterize the clinical symptoms, presentations, and treatments of nSCC in patients with darker skin types. A systematic review of PubMed and Embase was performed in May 2023 for all peer-reviewed, English-language nSCC studies involving individuals with Fitzpatrick types IV-VI. Most tumors were located on the fingernails (84%), with the right third finger being the most frequently affected (31%). The nail bed (67%) exhibited a higher prevalence than the lateral/proximal nail folds (33%). The duration of symptoms before diagnosis ranged from 1 month to 7 years. nSCC was most commonly treated with Mohs surgery (38%), followed by amputation (35%). Our study was limited to case reports because of a lack of large nSCC studies that provide information on race or images of each patient. These tumors are generally slow-growing yet often misdiagnosed, leading to delays in presentation and diagnosis. Increased awareness about nSCC in phototype IV-VI individuals will reduce misdiagnoses, unnecessary treatment, and recurrences.
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Affiliation(s)
- Michelle J Chang
- Department of Dermatology, State University of New York Downstate Medical Center, Brooklyn, NY, USA
- Department of Dermatology, Veterans Affairs Medical Center, Brooklyn, New York, USA
| | - Michelle Schwartz Kahn
- Department of Dermatology, State University of New York Downstate Medical Center, Brooklyn, NY, USA
- Department of Dermatology, Veterans Affairs Medical Center, Brooklyn, New York, USA
| | - Amor Khachemoune
- Department of Dermatology, State University of New York Downstate Medical Center, Brooklyn, NY, USA
- Department of Dermatology, Veterans Affairs Medical Center, Brooklyn, New York, USA
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2
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Haynes D, Haneke E, Rubin AI. Clinical, onychoscopic, nail clipping, and histopathological findings of malignant onychopapilloma. J Cutan Pathol 2024. [PMID: 38563529 DOI: 10.1111/cup.14620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 03/04/2024] [Accepted: 03/17/2024] [Indexed: 04/04/2024]
Abstract
This report describes the clinical, onychoscopic, nail clipping, and histopathologic features of a malignant onychopapilloma. A 71-year-old male presented to our outpatient clinic for a stable, asymptomatic lesion on his left middle finger that had been present for 2 years. Prior nail clipping histopathology showed nail plate thinning with subungual abnormal onychocytes. Clinical examination revealed a 2-mm-wide streak of longitudinal xanthonychia extending to the proximal nail fold, with distal hyperkeratosis and onycholysis. Onychoscopy showed irregular longitudinal nail plate ridging with scattered punctate hemorrhagic foci. An excisional nail unit biopsy demonstrated cellular atypia of the nail bed epithelium, matrix metaplasia, longitudinal abnormal onychocytes, increased Ki-67 staining, and negative HPV immunoperoxidase staining, confirming the diagnosis of malignant onychopapilloma.
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Affiliation(s)
- Dylan Haynes
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Eckart Haneke
- Dermatology Practice Dermaticum, Freiburg, Germany
- Department of Dermatol, Inselspital, Univ Berne, Switzerland
- Centro Dermatol Epidermis, Inst CUF, Porto, Portugal
| | - Adam I Rubin
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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3
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Veerabagu SA, Zhang J, Krausz AE, Fix WC, Cheng B, Sobanko JF, Etzkorn JR, Shin TM, Higgins HW, Giordano CN, McMurray SL, Walker JL, Miller CJ. Low local recurrence rates after Mohs micrographic surgery for cutaneous squamous cell carcinoma of the nail unit. J Am Acad Dermatol 2024; 90:832-833. [PMID: 38043591 DOI: 10.1016/j.jaad.2023.11.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 11/06/2023] [Accepted: 11/21/2023] [Indexed: 12/05/2023]
Affiliation(s)
- Surya A Veerabagu
- Department of Dermatology, University of New Mexico, Albuquerque, New Mexico
| | - Junqian Zhang
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Aimee E Krausz
- Department of Dermatology, Main Line Health, Paoli, Pennsylvania
| | - William C Fix
- Division of Dermatology, Albert Einstein College of Medicine, Bronx, New York
| | - Brian Cheng
- Department of Medicine, Indiana University, Vincennes, Indiana
| | - Joseph F Sobanko
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeremy R Etzkorn
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Thuzar M Shin
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - H William Higgins
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Cerrene N Giordano
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stacy L McMurray
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joanna L Walker
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Christopher J Miller
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
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4
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Jariwala NN, Dasilva DR, Sobanko JF, Rubin AI. Modified distal digital block for nail unit surgery. J Am Acad Dermatol 2023; 89:e209-e210. [PMID: 34752825 DOI: 10.1016/j.jaad.2021.10.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 10/12/2021] [Accepted: 10/28/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Neha N Jariwala
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Diego Ruiz Dasilva
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joseph F Sobanko
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Adam I Rubin
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
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5
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Cascardo CA, Mansour MR, Mervak JE. Efficacy of available treatments for periungual and subungual pyogenic granulomas: A systematic review. JAAD Int 2023; 12:142-146. [PMID: 37409317 PMCID: PMC10319297 DOI: 10.1016/j.jdin.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Affiliation(s)
| | - Meghan R. Mansour
- Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Julie E. Mervak
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan
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6
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Hamad MN, Ravella KC, Lipman MD, Mejia A. Local and Systemic Nail Plate Abnormalities: A Clinical Review. J Hand Surg Am 2023; 48:931-940. [PMID: 37191602 DOI: 10.1016/j.jhsa.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 01/16/2023] [Accepted: 04/09/2023] [Indexed: 05/17/2023]
Abstract
Nail disorders are often difficult to recognize and diagnose because of the subtlety of their presentation and their shared overlapping features that are common to several conditions. Experientially, this is further complicated by the fact that specific training on diagnosis of nail pathologies varies substantially across most residency programs and for a majority of medical and surgical specialties. To distinguish these presentations from true, potentially deleterious nail disorders, clinicians should have familiarity with the most commonly occurring nail pathologies and their associations, and use a systematic approach when examining or evaluating alterations in the nails. In the present study, we review the most common clinical disorders affecting the nail apparatus.
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Affiliation(s)
- Mohammed Nazmy Hamad
- Department of Orthopaedic Surgery, University of Illinois Medical Center at Chicago, Chicago, IL
| | - Krishna C Ravella
- Department of Orthopaedic Surgery, University of Illinois Medical Center at Chicago, Chicago, IL.
| | - Marc D Lipman
- Department of Orthopaedic Surgery, University of Illinois Medical Center at Chicago, Chicago, IL
| | - Alfonso Mejia
- Department of Orthopaedic Surgery, University of Illinois Medical Center at Chicago, Chicago, IL
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7
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Zhou Q, Wang W, Xu J, Chen Z. High-frequency ultrasonography index in evaluation of pincer nail. Skin Res Technol 2023; 29:e13306. [PMID: 36973987 PMCID: PMC10155790 DOI: 10.1111/srt.13306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 01/21/2023] [Accepted: 02/26/2023] [Indexed: 03/19/2023]
Abstract
BACKGROUND The measurements of width index, height index, and curvature index were used for assessment of the curvature severity. Nevertheless, both sides of the nail root are buried subcutaneously, impossibility in measuring the width index correctly. MATERIALS AND METHODS We developed a technique to measure the index under high-frequency ultrasonography (HF-USG). RESULTS There was good agreement between the HF-USG index and the result examined after surgery. CONCLUSION The observation on HF-USG helps to distinguish between ingrown nail and pincer nail. The HF-USG index will be useful in the examination and measurement of nail roots buried subcutaneously or nail penetration under the hypertrophic lateral nail fold, and comparing the effectiveness among treatments for pincer nail objectively.
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Affiliation(s)
- Qiaochu Zhou
- Wenzhou Hospital of Integrated Traditional Chinese and Western MedicineAffiliated Hospital of Integrated Traditional Chinese and Western Medicine of Shanghai University, Dermatology DepartmentWenzhouChina
| | - Wei Wang
- Wenzhou Hospital of Integrated Traditional Chinese and Western MedicineAffiliated Hospital of Integrated Traditional Chinese and Western Medicine of Shanghai University, Dermatology DepartmentWenzhouChina
| | - Jie Xu
- Wenzhou Hospital of Integrated Traditional Chinese and Western MedicineAffiliated Hospital of Integrated Traditional Chinese and Western Medicine of Shanghai University, Dermatology DepartmentWenzhouChina
| | - ZhiWei Chen
- Wenzhou Hospital of Integrated Traditional Chinese and Western MedicineAffiliated Hospital of Integrated Traditional Chinese and Western Medicine of Shanghai University, Dermatology DepartmentWenzhouChina
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8
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Barone H, Schaeffer M, Buckland M, LaFond AA, Krach K. Squamous Cell Carcinoma in Situ of the Nail Unit: Current Evidence and Recommendations for Patient Centered Treatment. J Cutan Med Surg 2023; 27:51-59. [PMID: 36285750 DOI: 10.1177/12034754221134226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Squamous cell carcinoma in situ of the hand and nail is an infrequent tumor but represents the majority of hand and nail malignancies. While the conventional treatments of invasive nail unit squamous cell carcinoma include Mohs micrographic surgery, wide local excision, or distal digit amputation, no standardized management paradigm for in situ disease exists and the necessity of surgical options is debated. This review aims to discuss the most commonly reported treatment methods and critically assess relevant management considerations in order to facilitate appropriate treatment decisions for nail unit SCCis across dermatologic practice settings. Assessment of the current literature reveals insufficient evidence to determine a standardized treatment for nail unit squamous cell carcinoma in situ. Rather, management is greatly impacted by multiple factors including the presence of subungual involvement, surgical candidacy, importance of curative treatment, and patient preferences regarding cosmesis and function versus cure. When cure is desired, Mohs micrographic surgery is the treatment of choice in most cases. In the setting of desired curative intent, but poor surgical candidacy, radiotherapy may be effective and provide a reasonable chance of functional and cosmetic preservation. Other methods including photodynamic therapy, electrodesiccation and curettage, cryotherapy, and intralesional chemotherapeutics may be appropriate in specific circumstances, but are generally limited by lack of evidence or impracticalities. Lastly, observation with palliation may be appropriate when considering exceedingly rare disease-related mortality.
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Affiliation(s)
- Hope Barone
- 491069 Department of Dermatology, St. Joseph Mercy Hospital, Ann Arbor, MI, USA
| | - Madeline Schaeffer
- 491069 Department of Dermatology, St. Joseph Mercy Hospital, Ann Arbor, MI, USA
| | - Molly Buckland
- 491069 Department of Dermatology, St. Joseph Mercy Hospital, Ann Arbor, MI, USA
| | - Ann Ammond LaFond
- 491069 Department of Dermatology, St. Joseph Mercy Hospital, Ann Arbor, MI, USA
| | - Kent Krach
- 491069 Department of Dermatology, St. Joseph Mercy Hospital, Ann Arbor, MI, USA.,491069 Midwest Center for Dermatology, Clinton, MI, USA
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Dika E, de Biase D, Lambertini M, Alessandrini AM, Acquaviva G, De Leo A, Tallini G, Ricci C, Starace M, Misciali C, Piraccini BM. Mutational landscape in squamous cell carcinoma of the nail unit. Exp Dermatol 2022; 31:854-861. [PMID: 34951714 DOI: 10.1111/exd.14518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 11/08/2021] [Accepted: 12/21/2021] [Indexed: 02/05/2023]
Abstract
Squamous cell carcinoma (SCC) is the most common malignancy of the nail unit. Pathogenetic mechanisms are yet to be determined, and a deeper molecular characterization of this disease is still necessary. The aim was to obtain a molecular characterization of NU SCC samples using an NGS approach to identify the genetic drivers involved in this tumor. The presence of HPV infection was also assessed. Furthermore, the mutational status was correlated with specific clinical-pathological features for a better insight into the carcinogenesis of this uncommon tumor. We analysed twenty paraffin-embedded nail unit SCC samples from patients diagnosed with primary SCC of the nail unit by next genome sequencing. In the 20 tested samples, the neoplastic cells enrichment ranged from 10% to 50% (mean value: 25.7%). In 14/20 cases (70.0%), at least one mutation was detected; whereas in the other six cases (30.0%), no alterations were observed ('wild-type/WT cases'). Overall, a total of 23 mutations were identified in the 20 specimens. TP53 was the most mutated gene (6/20 cases, 30.0%), while cKit, GNAS, EGFR, DICER1 and CTNNB1 were observed in one sample each (5.0%). No clinical-pathological parameters (age, sex, depth of invasion-DOI, histological subtype, grading and HPV) were significantly associated with the mutational status. The nail unit SCC mutational landscape appeared to be heterogeneous, favouring the hypothesis of a complex pathogenesis and an interaction of multiple elements, including HPV infections. This wealth of information undoubtedly improves our understanding of SCC biology.
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Affiliation(s)
- Emi Dika
- Dermatology, IRCCS di Policlinico Sant'Orsola, Bologna, Italy
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Dario de Biase
- Department of Pharmacy and Biotechnology, Molecular Diagnostic Unit, University of Bologna, Bologna, Italy
| | - Martina Lambertini
- Dermatology, IRCCS di Policlinico Sant'Orsola, Bologna, Italy
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Aurora Maria Alessandrini
- Dermatology, IRCCS di Policlinico Sant'Orsola, Bologna, Italy
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Giorgia Acquaviva
- Department of Medicine, Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale), Molecular Diagnostic Unit, University of Bologna, Azienda USL di Bologna, Bologna, Italy
| | - Antonio De Leo
- Department of Medicine, Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale), Molecular Diagnostic Unit, University of Bologna, Azienda USL di Bologna, Bologna, Italy
| | - Giovanni Tallini
- Department of Medicine, Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale), Molecular Diagnostic Unit, University of Bologna, Azienda USL di Bologna, Bologna, Italy
| | - Costantino Ricci
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
- Pathology Unit, Maggiore Hospital, Azienda USL di Bologna, Bologna, Italy
| | - Michela Starace
- Dermatology, IRCCS di Policlinico Sant'Orsola, Bologna, Italy
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Cosimo Misciali
- Dermatology, IRCCS di Policlinico Sant'Orsola, Bologna, Italy
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Bianca Maria Piraccini
- Dermatology, IRCCS di Policlinico Sant'Orsola, Bologna, Italy
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
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10
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Szymoniak-Lipska M, Polańska A, Jenerowicz D, Lipski A, Żaba R, Adamski Z, Dańczak-Pazdrowska A. High-Frequency Ultrasonography and Evaporimetry in Non-invasive Evaluation of the Nail Unit. Front Med (Lausanne) 2021; 8:686470. [PMID: 34195212 PMCID: PMC8236586 DOI: 10.3389/fmed.2021.686470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 05/12/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The nail unit (NU) is a complex structure that performs a number of functions, including protection, defense, manipulation, and palpation. Non-invasive research methods can facilitate the recognition of NU structure and function. Evaporimetry and HF-USG due to their availability of equipment and low research costs seem to be particularly noteworthy, but so far have been assessed to a limited extent. The aim of the presented study was to check the usefulness of TOWL and HF-USG in examination of NU. Materials and Methods: A total of 58 volunteers aged 25-65 years (mean age: 41 ± 10.16 years) were qualified for the study. The subjects did not present symptoms of clinically evident onychopathy and did not suffer from any dermatoses associated with lesions occurring within the NU. Additionally, the patients did not suffer from systemic diseases that could affect NU (including heart, lung, and endocrine diseases). In all volunteers, the measurement of TOWL and 20 MHz ultrasonography [high-frequency ultrasonography (HF-USG)] with the special emphasis on determination of nail plate thickness were performed. Results: Analysis of 464 HF-USG images revealed that the nail plate presented as two hyperechoic, parallel streaks (railway sign) with a linear hypoechoic middle layer between them. Matrix was visualized as a hypoechoic structure with blurred boundaries, mostly within the fourth and fifth fingers and more often in women. We found statistically significant correlations between the type of a finger and the thickness of the nail plate both in the entire study group and taking into account gender. In the dominant hand, the results were r = -0.341; p < 0.001; r = -0.417, p < 0.001; and r = 0.337; p = 0.001 (for the whole group, for women, and for men, respectively). In the non-dominant hand, the results were r = -0.465; p < 0.001; r = -0.493, p < 0.01; and r = -0.503; p < 0.01 (for the whole group, for women, and for men, respectively). There were statistically significant differences in the thickness of the nail plates of the corresponding types of fingers between female and male NUs. Statistically significant correlations were found between the type of a finger and the TOWL value in the whole group and taking into account gender (p < 0.05), except for the non-dominant hand in men. There were no statistically significant differences in the TOWL values of the corresponding types of fingers between male and female NUs (p > 0.05). There was no statistically significant correlation between the TOWL value and the nail plate thickness in any of the tested NUs, apart from the one statistically significant correlation in nd5 (r = 0.390, p = 0.021). Conclusions: To sum up, non-invasive methods, such as HF-USG and TOWL, enable assessment of the NU and are useful in examination of its structure and function. HF-USG shows characteristic elements of NUs that can be distinguished because of differences in their echogenicity. The thickness of the nail plate and TOWL depend on the type of finger, and show a relationship with gender.
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Affiliation(s)
| | - Adriana Polańska
- Department of Dermatology and Venereology, Poznan University of Medical Sciences, Poznan, Poland
| | - Dorota Jenerowicz
- Department of Dermatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Adam Lipski
- Department of Urology, Poznań University of Medical Sciences, Poznan, Poland
| | - Ryszard Żaba
- Department of Dermatology and Venereology, Poznan University of Medical Sciences, Poznan, Poland
| | - Zygmunt Adamski
- Department of Dermatology, Poznan University of Medical Sciences, Poznan, Poland
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11
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Rubin AI, Haneke E. A fresh look at the histopathology of trachyonychia. J Cutan Pathol 2021; 48:349-350. [PMID: 33476045 DOI: 10.1111/cup.13968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 01/10/2021] [Accepted: 01/12/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Adam I Rubin
- Department of Dermatology, Hospital of the University of Pennsylvania, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Section of Pediatric Dermatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Eckart Haneke
- Department of Dermatology, Inselspital, University of Berne, Bern, Switzerland.,Centro de Dermatología Epidermis, Instituto CUF, Porto, Portugal.,Dermatology Practice Dermaticum, Freiburg, Germany
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12
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Gaddis KJ, Wolfe J, Shin T, Rubin AI. Onycholemmal carcinoma with prominent dystrophic calcification and review of the literature. J Cutan Pathol 2018; 45:643-646. [PMID: 34493027 DOI: 10.1111/cup.13313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 06/20/2018] [Accepted: 06/25/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Kevin J Gaddis
- Department of Dermatology, Hospital of the University of Pennsylvania, 3600 Spruce Street, 2 Maloney Building, Philadelphia, Pennsylvania, 19104, USA
| | - Jonathan Wolfe
- Department of Dermatology, Hospital of the University of Pennsylvania, 3600 Spruce Street, 2 Maloney Building, Philadelphia, Pennsylvania, 19104, USA
| | - Thuzar Shin
- Department of Dermatology, Hospital of the University of Pennsylvania, 3600 Spruce Street, 2 Maloney Building, Philadelphia, Pennsylvania, 19104, USA
| | - Adam I Rubin
- Department of Dermatology, Hospital of the University of Pennsylvania, 3600 Spruce Street, 2 Maloney Building, Philadelphia, Pennsylvania, 19104, USA
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13
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Starace M, Alessandrini A, Dika E, Piraccini BM. Squamous cell carcinoma of the nail unit. Dermatol Pract Concept 2018; 8:238-244. [PMID: 30116671 PMCID: PMC6092066 DOI: 10.5826/dpc.0803a17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 02/28/2018] [Indexed: 10/31/2022] Open
Abstract
Squamous cell carcinoma (SCC) of the nail apparatus is a rare malignant tumor that usually originates underneath the nail plate and grows slowly with possible bone invasion. The etiology remains unknown, although a strong association with different conditions, such as high-risk human papillomavirus (HPVs), trauma, or radiation exposure has been demonstrated. Nail SCC is called "the great mimicker nail tumor" because different clinical presentations may coexist, resembling benign or malignant nail lesions. For this reason, there is often a significant delay between the onset of nail SCC and the diagnosis. Clinical manifestation includes onycholysis and erythema, while in the advanced stages nail ulceration can be observed. The association with pain, swelling, and inflammation usually indicates an invasive SCC with involvement of the underlying bone. Metastasis is rare but possible with involvement of lymph nodes. A multidisciplinary approach to assessment, management, and follow-up is advised. Using careful examination and modern diagnostic methods, including onychoscopy, biopsy, and histopathology, will help identify SCC and prevent the invasive progression. X-ray is important to investigate the bone invasion to determine the best surgical approach that will have satisfying cosmetic and functional outcomes. Nevertheless, local excision with sufficient surgical margins, best if using Mohs surgery, is usually sufficient and superior to amputation of the distal phalanx. This review aims to highlight the correct approach in suspected SCC of the nail unit.
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Affiliation(s)
- Michela Starace
- Department of Specialized, Diagnostic and Experimental Medicine, University of Bologna, Bologna, Italy
| | - Aurora Alessandrini
- Department of Specialized, Diagnostic and Experimental Medicine, University of Bologna, Bologna, Italy
| | - Emi Dika
- Department of Specialized, Diagnostic and Experimental Medicine, University of Bologna, Bologna, Italy
| | - Bianca Maria Piraccini
- Department of Specialized, Diagnostic and Experimental Medicine, University of Bologna, Bologna, Italy
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14
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Park JH, Lee DY, Jang KT, Ha SY, Kwon GY, Lee KH, Shim JS, Kwon EJ. CD13 is a marker for onychofibroblasts within nail matrix onychodermis: Comparison of its expression patterns in the nail unit and in the hair follicle. J Cutan Pathol 2017; 44:909-914. [PMID: 28708295 DOI: 10.1111/cup.13006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 06/16/2017] [Accepted: 07/11/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND We previously demonstrated the presence of onychodermis, a specialized mesenchymal cell population beneath the nail matrix and proximal nail bed demonstrating CD10 expression. We hypothesize that the onychodermis could be the nail analog of the follicular dermal papilla, which is known to express CD13. We compare CD13 expression patterns between specialized mesenchymes of nail and hair, and compare these findings with CD10 expression patterns. METHODS CD10 and CD13 immunohistochemistry was performed on polydactyly and adult cadaveric nail units, and on hair follicles in scalp nevus sebaceus excision specimens. RESULTS CD10 and CD13 were expressed in the mesenchyme below the nail matrix and nail bed. Stronger CD13 expression was observed in the mesenchyme containing onychofibroblasts below the nail matrix compared with that below the nail bed. CD10 was expressed in the dermal sheath of terminal hair follicles, but it was expressed in the dermal sheath and follicular dermal papilla of primitive hair follicles within nevus sebaceus lesions. CD13 was expressed in the dermal sheath and dermal papilla of terminal and primitive hair follicles. CONCLUSION CD13 may be a marker for onychofibroblasts within nail matrix onychodermis. We demonstrate CD13 expression in the specialized mesenchymes of both nail and hair.
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Affiliation(s)
- Ji-Hye Park
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, South Korea
| | - Dong-Youn Lee
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, South Korea
| | - Kee-Taek Jang
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, South Korea
| | - Sang-Yun Ha
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, South Korea
| | - Ghee Young Kwon
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, South Korea
| | - Kyung-Hoon Lee
- Department of Anatomy, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, South Korea
| | - Jong Sup Shim
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, South Korea
| | - Eun Ji Kwon
- Dermpath Diagnostics, Port Chester, New York
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15
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Abstract
Certain nail changes are specific for various dermatological disorders. In addition, examination of nails may also provide an insight into more sinister systemic manifestations in the form of both subtle as well as specific changes. These findings may present as a defect of various anatomical components of the nail unit; nail matrix, nail plate and/or nail bed or vasculature. This article is an attempt to equip the dermatologists with a foresight to suspect and diagnose the unapparent systemic connotations that may be possible by a simple but detailed nail examination.
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Affiliation(s)
- Archana Singal
- Department of Dermatology and STD, University College of Medical Sciences and Guru Teg Bahadur Hospital, University of Delhi, New Delhi, India
| | - Rahul Arora
- Department of Dermatology and STD, University College of Medical Sciences and Guru Teg Bahadur Hospital, University of Delhi, New Delhi, India
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16
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Haenssle HA, Blum A, Hofmann-Wellenhof R, Kreusch J, Stolz W, Argenziano G, Zalaudek I, Brehmer F. When all you have is a dermatoscope- start looking at the nails. Dermatol Pract Concept 2014; 4:11-20. [PMID: 25396079 PMCID: PMC4230252 DOI: 10.5826/dpc.0404a02] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Accepted: 05/16/2014] [Indexed: 12/15/2022] Open
Abstract
Pigmented and non-pigmented nail alterations are a frequent challenge for dermatologists. A profound knowledge of clinical and dermatoscopic features of nail disorders is crucial because a range of differential diagnoses and even potentially life-threatening diseases are possible underlying causes. Nail matrix melanocytes of unaffected individuals are in a dormant state, and, therefore, fingernails and toenails physiologically are non-pigmented. The formation of continuous, longitudinal pigmented streaks (longitudinal melanonychia) may either be caused by a benign activation of matrix melanocytes (e.g., as a result of trauma, inflammation, or adverse drug reactions) or by a true melanocytic proliferation (e.g., in a nevus or melanoma). In general, non-continuous nail alterations, affecting only limited parts of the nail apparatus, are most frequently of non-melanocytic origin. Important and common differential diagnoses in these cases are subungual hemorrhage or onychomycosis. In addition, foreign bodies, bacterial infections, traumatic injuries, or artificial discolorations of the nail unit may less frequently cause non-continuous nail alterations. Many systemic diseases that may also show involvement of the nails (e.g., psoriasis, atopic dermatitis, lichen planus, alopecia areata) tend to induce alterations in numerous if not all nails of the hands and feet. A similar extensive and generalized alteration of nails has been reported after treatment with a number of systemic drugs, especially antibiotics and cytostatics. Benign or malignant neoplasms that may also affect the nail unit include glomus tumor, Bowen's disease, squamous cell carcinoma, and rare collision tumors. This review aims to assist clinicians in correctly evaluating and diagnosing nail disorders with the help of dermatoscopy.
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Affiliation(s)
- Holger A Haenssle
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany ; Department of Dermatology, Venereology and Allergology, University Medical Center Heidelberg, Heidelberg, Germany
| | | | | | | | - Wilhelm Stolz
- Clinic of Dermatology and Allergology, Hospital Munich-Schwabing, Munich, Germany
| | - Giuseppe Argenziano
- Dermatology and Skin Cancer Unit, Arcispedale Santa Maria Nuova (IRCCS), Reggio Emilia, Italy
| | | | - Franziska Brehmer
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany
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17
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Nordin P, Stenquist BC. Aggressive curettage-cryosurgery for human papillomavirus-16 associated subungual squamous cell carcinoma in situ. J Cutan Aesthet Surg 2013; 6:155-7. [PMID: 24163533 PMCID: PMC3800291 DOI: 10.4103/0974-2077.118417] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Squamous cell carcinoma (SCC) in situ is an uncommon tumour of the nail unit. Mohs micrographic surgery or wide surgical excision are often the preferred treatments. As an alternative therapy two patients with human papillomavirus (HPV)-16 associated SCC in situ were treated by curettage-cryosurgery. After a careful curettage with different-sized curettes freezing with liquid nitrogen in a double freeze-thaw was performed. Both patients were treated successfully and healed completely within 3 months. No adverse events were observed during a follow-up of at least 5 years and no recurrences were noted. Curettage-cryosurgery might be a safe and non-resource-demanding alternative treatment for patients with subungual SCC in situ.
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Affiliation(s)
- Peter Nordin
- Dermatology Clinic, Läkarhuset, Gothenburg, Sweden
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