V Carlioz1, M Perier-Muzet1, S Debarbieux1, M Amini-Adle1, S Dalle2, G Duru1,3, L Thomas2. 1. Dermatology Department, Centre Hospitalier de Lyon Sud, Hospices civils de Lyon, Lyon, France. 2. Centre Hospitalier de Lyon Sud, Université Claude Bernard Lyon, Centre de recherche sur le cancer de Lyon, Lyon, France. 3. Mathematics Department, Claude Bernard Lyon 1 University, Lyon, France.
Abstract
BACKGROUND: Subungual squamous cell carcinoma (SU-SCC) is the most common malignant tumor of the nail unit. Intraoperative nail dermoscopy has only been described for pigmented tumors, onychomatricoma and glomus tumors. AIMS: Description of intraoperative dermoscopy features of SU-SCC. METHODS: A monocentric retrospective cohort of 53 SU-SCC cases over a 5-years period was reviewed by six examiners who individually scored 31 intraoperative dermoscopic criteria as present or absent. For each criterion, frequency and inter-observer agreement was evaluated, then data were compared and a consensus was reached. RESULTS: No criteria had perfect or substantial inter-observer agreement. -Anatomy and architecture: most tumors involved both nail bed and matrix (n=34, 64,2%) and had unparalleled lateral side edges (n=36, 67,9%). -Vascular features: many different patterns were found: dotted vessels (n=49, 92,5%), irregular vessels (n=47, 88,7%), curved vessels (n=46, 86.8%), sagittal vessels (n=45, 84,9%), "milky-red area" (n=42, 79,2%), linear and regular vessels (n=30, 56,6%), coiled and hairpin vessels (n=23, 43,4%) and arborizing vessels (n=16, 30,2%). -Pigmented dermoscopy structures: dotted purpura, gray granulation and splinter hemorrhage were found in 49 (20,8%), 9 (17%) and 9 (17%) cases. -Other dermoscopic signs: pink background, translucent structureless area, whitish scaly areas, distal plug, yellowish scales and dots, and "digitiform" proximal edge were respectively found in 49 (84,9%), 49 (84,9%), 43 (81,1%), 37 (69,8%), 28 (52,8%) and 22 (41,5%) cases. CONCLUSION: Analysis of this first large series of SU-SCC studied by intra-operative dermoscopy suggests that it gives useful information to better approach the diagnosis and to target the biopsy. This article is protected by copyright. All rights reserved.
BACKGROUND: Subungual squamous cell carcinoma (SU-SCC) is the most common malignant tumor of the nail unit. Intraoperative nail dermoscopy has only been described for pigmented tumors, onychomatricoma and glomus tumors. AIMS: Description of intraoperative dermoscopy features of SU-SCC. METHODS: A monocentric retrospective cohort of 53 SU-SCC cases over a 5-years period was reviewed by six examiners who individually scored 31 intraoperative dermoscopic criteria as present or absent. For each criterion, frequency and inter-observer agreement was evaluated, then data were compared and a consensus was reached. RESULTS: No criteria had perfect or substantial inter-observer agreement. -Anatomy and architecture: most tumors involved both nail bed and matrix (n=34, 64,2%) and had unparalleled lateral side edges (n=36, 67,9%). -Vascular features: many different patterns were found: dotted vessels (n=49, 92,5%), irregular vessels (n=47, 88,7%), curved vessels (n=46, 86.8%), sagittal vessels (n=45, 84,9%), "milky-red area" (n=42, 79,2%), linear and regular vessels (n=30, 56,6%), coiled and hairpin vessels (n=23, 43,4%) and arborizing vessels (n=16, 30,2%). -Pigmented dermoscopy structures: dotted purpura, gray granulation and splinter hemorrhage were found in 49 (20,8%), 9 (17%) and 9 (17%) cases. -Other dermoscopic signs: pink background, translucent structureless area, whitish scaly areas, distal plug, yellowish scales and dots, and "digitiform" proximal edge were respectively found in 49 (84,9%), 49 (84,9%), 43 (81,1%), 37 (69,8%), 28 (52,8%) and 22 (41,5%) cases. CONCLUSION: Analysis of this first large series of SU-SCC studied by intra-operative dermoscopy suggests that it gives useful information to better approach the diagnosis and to target the biopsy. This article is protected by copyright. All rights reserved.