Onycholemmal carcinoma: a morphologic comparison of 6 reported cases

Area of Science:

• Dermatology
• Oncology
• Pathology

Background:

• Onycholemmal carcinoma is a rare subcategory of squamous cell carcinoma, frequently misdiagnosed.
• Historically, amputation was the standard treatment for affected digits.

Observation:

• This study presents 6 new cases of onycholemmal carcinoma.
• Clinical presentation included onycholysis, periungual erythema, and pain, with symptom duration of 6 months to 2 years.
• Histological examination revealed a well-differentiated, infiltrative squamous lesion with a lobulated and cystic growth pattern.

Findings:

• Mohs micrographic surgery and radiation therapy were utilized as primary treatment modalities.
• These digit-sparing treatments successfully maintained digit functionality and achieved remission in the reported cases.
• The study observed an indolent clinical course for onycholemmal carcinoma.

Implications:

• Onycholemmal carcinoma is a distinct squamous cell carcinoma originating from the nail isthmus.
• Less aggressive, digit-sparing treatments such as Mohs micrographic surgery and radiation therapy should be considered for onycholemmal carcinoma.
• These findings suggest a shift towards conservative management, preserving digit function.