Subungual Squamous Cell Carcinoma Associated with Long Standing Onychomycosis: Aggressive Surgical Approach with a Favourable Outcome


  • Yavor Grigorov University Hospital Lozenetz, Department of Orthopedics and Traumatology, Sofia
  • Stanislav Philipov Sofia University St. Kliment Ohridski - Faculty of Medicine, Department of General and Clinical Pathology, Sofia
  • James Patterson University of Virginia Health System, Pathology, Charlottesville, Virginia
  • Georgi Tchernev Medical Institute of the Ministry of Interior, Dermatology, Venereology and Dermatologic Surgery; Onkoderma, Private Clinic for Dermatologic Surgery, Dermatology and Surgery, Sofia 1407
  • Serena Gianfaldoni University G. Marconi of Rome, Dermatology and Venereology, Rome 00192
  • Torello Lotti Chair of Dermatology, University of Rome G. Marconi, Rome 00186
  • Uwe Wollina Department of Dermatology and Allergology at the Academic Teaching Hospital Dresden-Friedrichstadt in Dresden



Subungual squamous cell carcinoma, nail neoplasms, HPV, viral wart, surgery, onychomycosis


BACKGROUND: Tumours of the nail bed are rare. Squamous cell carcinoma is the most frequent among them. Chronic infection, chemical or physical trauma/microtrauma, genetic disorders such as congenital ectodermal dysplasia, radiation, tar, arsenic or exposure to minerals, sun exposure, immunosuppression, and previous HPV infection have all been discussed as etiologic factors. The diagnosis is often delayed because of the variety of clinical manifestations, often resembling benign or common infectious processes. Rapidly growing ulcerative lesions should also be considered as potential malignancy. Furthermore, a lack of antifungal or antibacterial treatment response is the most indicative symptom, always requiring subungual biopsy. Early diagnosis is of great importance for therapeutic effectiveness.

CASE PRESENTATION: We present a case of subungual squamous cell carcinoma, associated with long-lasting onychomycosis in a 76-year-old female patient, treated with amputation of the distal phalanx and the distal part of the proximal phalanx.

CONCLUSION: Although there are no available data in the literature to confirm or reject the contribution of the chronic nail infection to the malignant process, we emphasise the importance of this co-existence regarding the possible disguising of the malignant process. An early biopsy of a chronic persistent nail lesion may be preventive and beneficial regarding avoiding more aggressive treatments and achieving a favourable prognosis.


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How to Cite

Grigorov Y, Philipov S, Patterson J, Tchernev G, Gianfaldoni S, Lotti T, Wollina U. Subungual Squamous Cell Carcinoma Associated with Long Standing Onychomycosis: Aggressive Surgical Approach with a Favourable Outcome. Open Access Maced J Med Sci [Internet]. 2017 Jul. 21 [cited 2023 Feb. 4];5(4):480-2. Available from:

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