Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
J Am Acad Dermatol. 2013 Feb;68(2):290-5. doi: 10.1016/j.jaad.2012.07.015. Epub 2012 Aug 20.
We report 6 new cases of onycholemmal carcinoma, a rare, often misdiagnosed, subcategory of squamous cell carcinoma. All reported cases to date have been treated with amputation of the affected digit.
The purpose of this study was to present the clinical and pathological features of each new case and to discuss treatment options that spare digit functionality.
Hematoxylin-eosin stains were performed on tumor sections and examined using light microscopy. In situ hybridization using probes against human papillomavirus were examined in 1 case.
The female to male ratio was 1:1 with involvement of fingers in 3, thumb in 1, and toe in 1. Among the symptoms were onycholysis, periungual erythema, and pain; symptom duration ranged from 6 months to 2 years. Histologically, all cases showed a well-differentiated atypical infiltrative squamous proliferative lesion exhibiting a lobulated and cystic pattern of growth in the dermis. Abrupt keratinization reminiscent of trichilemmal keratinization was noted. Mohs micrographic surgery and radiation therapy were used as primary treatment modalities, maintaining digit functionality and achieving remission.
Limitations of this study included the small number of cases, the infrequency with which this tumor has been reported in the literature, and the inability to obtain follow-up on an older archival case.
Onycholemmal carcinoma is a distinct type of squamous cell carcinoma arising from the nail isthmus; its natural clinical course is indolent. In this regard less aggressive digit-sparing treatment modalities such as radiation or Mohs micrographic surgery should be considered.
我们报告了 6 例新的甲下外生骨瘤病例，这是一种罕见的、常被误诊的鳞状细胞癌亚类。迄今为止报告的所有病例均采用受影响指（趾）的截肢术进行治疗。
本研究的目的是介绍每例新病例的临床和病理特征，并讨论保留指（趾）功能的治疗选择。
对肿瘤切片进行苏木精-伊红染色，并使用光学显微镜进行检查。在 1 例中检查了针对人乳头瘤病毒的探针的原位杂交。
男女比例为 1:1，累及手指 3 例，拇指 1 例，脚趾 1 例。症状包括甲分离、甲周红斑和疼痛；症状持续时间从 6 个月到 2 年不等。组织学上，所有病例均表现为分化良好的非典型浸润性鳞状增生性病变，在真皮中呈分叶状和囊性生长模式。注意到类似于硬毛角化的突然角化。采用 Mohs 显微外科手术和放射治疗作为主要治疗方式，保持指（趾）功能并实现缓解。
本研究的局限性包括病例数量少、该肿瘤在文献中报道频率低以及无法获得旧存档病例的随访。
甲下外生骨瘤是一种源自甲半月的独特的鳞状细胞癌；其自然临床病程是惰性的。在这方面，应考虑采用侵袭性较小的保留指（趾）功能的治疗方式，如放射治疗或 Mohs 显微外科手术。
