伴有可疑骨侵袭的甲下浸润性鳞状细胞癌：一种治疗方案。
Subungual Invasive Squamous Cell Carcinoma with Doubtful Underlying Bone Invasion: A Treatment Proposal.
作者信息
Dominguez-Cherit Judith
机构信息
Department of Dermatology, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubiràn", Mexico City, Mexico.
出版信息
Skin Appendage Disord. 2021 Feb;7(2):108-111. doi: 10.1159/000511740. Epub 2020 Nov 24.
INTRODUCTION
Subungual squamous cell carcinoma (sSCC) is the most frequent malignant tumor of the nail unit. When suspecting sSCC, accurate diagnosis is supported by nail biopsy. Depth of invasion and histopathologic signs of human papillomavirus (HPV) infection are related to an unfavorable prognosis. In this case, it is necessary to rule out bone invasion by radiography or MRI, and in case of doubt, amputation is indicated.
CASE PRESENTATION
We present 2 cases of sSCC with a confirmatory biopsy of sSCC with HPV and invasion; in both cases, MRI was difficult to distinguish between bone invasion and bone marrow inflammation. Before amputating the distal phalanx, we decided to perform a bone biopsy during the excisional surgery. Neither case required amputation.
CONCLUSION
We propose that when an invasive sSCC is present and an MRI is doubtful of bone invasion, before amputating, a bone biopsy should be performed.
引言
甲下鳞状细胞癌（sSCC）是甲单位最常见的恶性肿瘤。怀疑患有sSCC时，甲活检有助于准确诊断。侵袭深度和人乳头瘤病毒（HPV）感染的组织病理学迹象与不良预后相关。在这种情况下，有必要通过X线摄影或磁共振成像（MRI）排除骨侵袭，如有疑问，则需进行截肢。
病例报告
我们报告2例经活检确诊为伴有HPV感染及侵袭的sSCC；在这2例病例中，MRI难以区分骨侵袭和骨髓炎症。在切除远端指骨之前，我们决定在切除手术期间进行骨活检。2例均无需截肢。
结论
我们建议，当存在侵袭性sSCC且MRI对骨侵袭存疑时，在截肢前应进行骨活检。
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