Stoll D M, Ackerman A B
Am J Dermatopathol. 1980 Fall;2(3):265-71. doi: 10.1097/00000372-198000230-00017.
Only 12 cases of lesions reputed to be subungual keratoacanthomas have been reported to our knowledge, and those have not been unequivocal by histologic and biologic criteria. Those 12 lesions have been tabulated by us and reviewed critically. In addition, we now provide two cases of keratoacanthomas in the subungual region that are histologically typical of keratoacanthomas found on hair-bearing skin. It appears to us that subungual keratoacanthoma is a specific type of keratoacanthoma that differs from the common solitary keratoacanthoma on hair bearing skin by 1) its similarity to verruca vulgaris clinically; 2) having more dyskeratotic cells and fewer neutrophils and eosinophils histologically; 3) being more vertical in orientation (longer than it is broad); 4) its failure to regress spontaneously; 5) its longer course; and 6) its tendency to destroy bone. Paradoxically, keratoacanthoma situated in the subungual region is a more destructive neoplasm than a squamous cell carcinoma there.
据我们所知，仅有12例病变被认为是甲下角化棘皮瘤，而从组织学和生物学标准来看，这些病例并不明确。我们已将这12例病变列表并进行了严格审查。此外，我们现在提供两例甲下区域的角化棘皮瘤病例，它们在组织学上与在有毛发皮肤处发现的角化棘皮瘤典型特征相符。在我们看来，甲下角化棘皮瘤是一种特殊类型的角化棘皮瘤，它与有毛发皮肤处常见的孤立性角化棘皮瘤的不同之处在于：1）临床外观上与寻常疣相似；2）组织学上具有更多的角化不良细胞，中性粒细胞和嗜酸性粒细胞较少；3）生长方向更垂直（长大于宽）；4）不会自发消退；5）病程更长；6）有破坏骨质的倾向。矛盾的是，位于甲下区域的角化棘皮瘤比该部位的鳞状细胞癌更具破坏性。
