Abstract

We reported a case of squamous cell carcinoma (SCC) of the nail bed, with very rapid multiple metastases in various organs. A 65-year-old man had a hyperkeratotic tumor which had been around the nail bed of his right 5th toe for two months. A digital X-ray film of the toe showed the disappearance of the digital phalanx. A biopsy specimen of the tumor led us to diagnose as poorly differentiated SCC. Amputation of the toe at the level of metatarsal bone and therapeutic dissection of the right ilio-inguinal and popliteal lymphnodes were performed. Additionaly the patient was followed by radiation therapy. Histologically, the tumor invaded the bone underneath, and two metastatic lymphnodes were detected on his right groin.
In spite of irradiation on his right foot toe and groin, many in-transit metastases appeared on his right leg and thigh three months later. Several times of resection and two courses of combination chemotherapy (cisplatin, 5-FU and peplomycin) could not inhibit the tumor progression. Bone and lung metastases occurred and he died seven months after the first visit.
Although the prognosis of subungual SCCs is thought to be relatively favorable, some cases may take a miserable course.