Endgames Case Scenario

Squamous cell carcinoma of the nail bed

BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h4640 (Published 02 September 2015) Cite this as: BMJ 2015;351:h4640
  1. A Nicholls, specialty registrar1,
  2. J Jacoby, consultant2,
  3. R Hartley, consultant1,
  4. D O’Connor, consultant1
  1. 1Department of Trauma and Orthopaedics, Poole Hospital NHS Trust, Poole BH15 2JB, UK
  2. 2Department of Radiology, Poole Hospital NHS Trust
  1. Correspondence to: A Nicholls alexnicholls{at}doctors.org.uk

A 75 year old man presented with a four month history of presumed paronychia of his right index finger. Antibiotic and antifungal treatment had not been effective. Destruction of the distal phalanx on plain radiographs was thought to be caused by osteomyelitis.

Surgical debridement showed a well defined subungual mass. Histological examination confirmed invasive, moderately differentiated squamous cell carcinoma of the nail bed with no infection.

Although the causes of squamous cell carcinoma are uncertain, it is the most common primary nail bed malignancy. Metastasis is rare and no regional lymphadenopathy was found. Amputation through the middle phalanx resulted in clear tumour margins.

Learning points:

  • Subungual squamous cell carcinoma can mimic benign conditions and should be suspected in atypical presentations

  • A multidisciplinary approach to the assessment, management, and follow-up of these lesions is advised

  • If in doubt, any bone or soft tissue tumour should be discussed with the appropriate tertiary referral service


Cite this as: BMJ 2015;351:h4640


  • Patient consent obtained.

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