Department of Dermatology, Centre Hospitalier Lyon-Sud - Pierre Bénite, Hospices Civils de Lyon, Lyon, France.
Dermatology. 2017;233(2-3):184-191. doi: 10.1159/000479059. Epub 2017 Aug 23.
Subungual squamous cell carcinoma (SSCC) is the most frequent tumor of the nail apparatus. Its diagnosis is often missed or delayed because the clinical presentation is atypical and can mimic other conditions. Accurate diagnosis can only be made by performing an appropriate surgical biopsy, but biopsy is painful and often leaves definitive dystrophic scars. The use of dermoscopy, a noninvasive technique, has been described to be useful for the preoperative evaluation of nail diseases.
To define the different clinical and dermoscopic presentations of SSCC and to compare them with onychomatricoma-associated clinical and dermoscopic features published in our previous study.
A retrospective review of 44 cases of SSCC seen in our institution over an 8-year period. Six observers scored 19 clinical criteria and 14 dermoscopic criteria as present or absent. Then, we compared those data to a previously published study about the preoperative diagnosis of onychomatricoma.
Only 1 dermoscopic criterion was significantly associated with SSCC compared to onychomatricoma: localized hyperkeratosis (odds ratio, OR = 6.25, p = 0.012, 95% confidence interval CI = 1.50-26.01). In contrast, parallel edges (OR = 0.03, p < 0,001, 95% CI = 0.003-0.20) and sharp demarcation of the lesion (OR = 0.24, p = 0.004, 95% CI = 0.09-0.63) can statistically significantly be considered as in favor of onychomatricoma. By contrast, we believe that the presence of unparalleled lateral edges of the nail lesion or of fuzzy edges are more in favor of SSCC.
Dermoscopy of the nail plate and of the nail free edge in SSCC provides useful information in order to better select cases to be submitted to biopsy.
甲下鳞状细胞癌（SSCC）是甲床最常见的肿瘤。由于临床表现不典型，可与其他疾病相混淆，因此其诊断常被忽视或延迟。只有通过适当的外科活检才能做出准确的诊断，但活检会带来疼痛，且常留下明确的营养不良性瘢痕。非侵入性技术皮肤镜的应用已被描述为对指甲疾病的术前评估有用。
定义 SSCC 的不同临床和皮肤镜表现，并将其与我们之前研究中报道的与甲瘤相关的临床和皮肤镜特征进行比较。
回顾性分析我院 8 年间收治的 44 例 SSCC 患者。6 名观察者对 19 项临床标准和 14 项皮肤镜标准进行评分，判断其为存在或不存在。然后，我们将这些数据与之前关于甲瘤术前诊断的研究进行了比较。
与甲瘤相比，只有 1 个皮肤镜标准与 SSCC 显著相关：局限性角化过度（优势比，OR=6.25，p=0.012，95%置信区间，CI=1.50-26.01）。相比之下，平行边缘（OR=0.03，p<0.001，95%CI=0.003-0.20）和病变锐利边界（OR=0.24，p=0.004，95%CI=0.09-0.63）可统计学显著地被认为对甲瘤有利。相反，我们认为甲病变无单侧边缘或边缘模糊更倾向于 SSCC。
SSCC 的甲甲板和甲游离缘的皮肤镜检查可提供有用的信息，以更好地选择需要活检的病例。
