Subungual squamous cell carcinoma of the toe: working toward a standardized therapeutic approach.

Subungual squamous cell carcinoma (SCC) is a rare malignancy with very few reported cases that occur on the toe. The etiology of these lesions is not known, and although this location is generally considered low risk for metastasis, cases of inguinal lymph node metastasis after toe amputation have been reported. Patients with subungual disease may meet criteria other than location that increase their risk for metastasis. Currently, no standardized approach to therapy for these patients has been established. In this article, we describe a patient with SCC of the right fourth toe with no clinical evidence of lymph-node metastasis. This patient underwent toe amputation and has done well for 2.5 years with no evidence of recurrence. We discuss this case of subungual SCC of the toe along with others in the literature to propose an optimal standardized approach for therapy and follow-up. In so doing, we aim to advance medical knowledge of subungual SCC and to improve patient care.