Wong Hoi-Shiwn, Li Fang, Jiang Jia-Yi, Huang Shu-Dai, Ji Xiang, Zhu Ping, Wang Da-Guang
Department of Dermatology and Venereology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China.
Department of Dermatology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China.
Indian J Dermatol Venereol Leprol. 2025 Jan-Feb;91(1):31-39. doi: 10.25259/IJDVL_912_2023.
Background Nail unit squamous cell carcinoma (nSCC) is a malignant subungual tumour. Although it has a low risk of metastasis and mortality, the tumour has a significant local recurrence rate. There is insufficient data to determine whether functional surgery is less effective than amputation for nSCC that does not involve the bone. Objectives We aimed to investigate existing data on the outcomes of functional surgery and amputation for nSCC without bone invasion. Materials and Methods We carried out an extensive search in PubMed, Embase, Cochrane Library, Web of Science, and Scopus for appropriate English-language academic papers, starting with the creation of individual resources until February 23, 2023. The main outcome was local recurrence. Initially, 2191 studies related to nSCC were selected. Information from every research study was retrieved and subdivided, comprising the year of publication, period, number of patients, age, gender distribution, tumour stage, type of intervention, number of recurrences, and follow-up period. Results Ten independent studies (319 lesions) were finally selected. Mohs micrographic surgery was the most reported surgical modality, followed by wide surgical excision and amputation. Local recurrence rates between Mohs micrographic surgery, wide surgical excision and amputation treatment were nearly identical. Other surgical methods included limited surgical excision, partial ablation, and limited excision until the clearing of margins, with recurrence rates up to 50%. Conclusions Given the functional impairment and psychological distress associated with phalanx amputation, functional surgery, including Mohs micrographic surgery and wide surgical excision , should be the preferred therapy for nSCC without bone involvement. Amputation should remain the preferred therapy for nSCC that involves the bone. Partial excision should be avoided. Further studies on whether Mohs micrographic surgery or wide surgical excision is a better option for nSCC not involving the bone are required.
背景 甲单位鳞状细胞癌（nSCC）是一种恶性甲下肿瘤。尽管其转移和死亡率风险较低，但该肿瘤的局部复发率较高。目前尚无足够数据确定对于不累及骨骼的nSCC，功能性手术是否比截肢手术效果差。目的 我们旨在研究关于不累及骨骼的nSCC进行功能性手术和截肢手术结果的现有数据。材料与方法 我们在PubMed、Embase、Cochrane图书馆、科学网和Scopus中进行了广泛检索，以查找合适的英文医学论文，检索起始于各数据库创建之时，截至2023年2月23日。主要结局为局部复发。最初，共筛选出2191项与nSCC相关的研究。提取并细分每项研究的信息，包括发表年份、时间段、患者数量、年龄、性别分布、肿瘤分期、干预类型、复发次数和随访期。结果 最终筛选出10项独立研究（共319个病灶）。莫氏显微描记手术是报道最多的手术方式，其次是广泛手术切除和截肢手术。莫氏显微描记手术、广泛手术切除和截肢手术的局部复发率几乎相同。其他手术方法包括有限手术切除、部分消融以及切缘阴性前的有限切除，复发率高达50%。结论 鉴于指骨截肢会导致功能障碍和心理困扰，对于不累及骨骼的nSCC，包括莫氏显微描记手术和广泛手术切除在内的功能性手术应作为首选治疗方法。对于累及骨骼的nSCC，截肢仍应作为首选治疗方法。应避免部分切除。对于不累及骨骼的nSCC，莫氏显微描记手术或广泛手术切除哪种是更好的选择，还需要进一步研究。
