Abstract

Verrucous carcinoma (VC) of the nail bed is an uncommon variant of squamous cell carcinoma. While the tumor is curable via early recognition and surgical intervention, it is often misdiagnosed as a benign condition, such as pyogenic granuloma, paronychia, and, most commonly, verruca vulgaris. This leads to delayed intervention and risk of bone invasion and/or extensive excision that may result in amputation. Herein, we present a case of a 68-year-old man with a left second fingernail verrucous carcinoma. The patient initially experienced left index finger tenderness. Over the course of 7 months, he developed a small scaly lesion on the radial aspect of his left index finger. Two view x-ray of the left hand was unremarkable for any bone abnormality. A nail biopsy was performed and histopathologic examination revealed endophytic, bulbous, and frond-like rete ridges with a blunt invasive border. Rare atypical squamous cells and mitotic figures were identified. There was no invasion of the underlying bone. A diagnosis of subungual verrucous carcinoma was made. Due to the local aggressive nature of this lesion, it is essential to make an early diagnosis to avoid unnecessary amputation.

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