Clinical cases


Introduction: Verrucous carcinoma is a tumor of old age. Diagnosis is usually delayed, requiring repeated, multiple, wide and deep biopsies.

Clinical case: A 68-year-old patient is consulted for a subungual keratosis nodular mass with involvement of the left nail fold of the right index finger, with an evolution of several months. X-ray of the right index finger shows periosteal reaction and lack of bone substance in the distal phalanx. At the histopathological examination hyperkeratosis, parakeratosis, papillomatosis and invasion of the underlying dermis with squamous neoplastic cell masses with nuclear pleomorphism and occasional mitosis appear. Amputation of the distal phalanx of the right index finger was performed.

Discussions: The subungual location of verrucous cancer is rare, and can affect the nail bed, dorsal or proximal fold of the nail. Histologically, there are few cellular atypias. The pathogenesis is unclear with the incrimination of chronic inflammatory factors, repeated microtraumas, HPV. The differential diagnosis must be made with Bowen’s disease, keratoacanthoma and vulgar wart. The treatment of choice consists of complete and wide surgical excision, sometimes amputation. Recurrences are common.