Nail unit squamous cell carcinoma in people with immunosuppression.
BACKGROUND
Nail unit squamous cell carcinoma (NUSCC) is uncommon and diagnosis is often initially incorrect or delayed. Immunosuppression appears important in the clinical behaviour of NUSCCs.


OBJECTIVE
To highlight the frequency and nature of immunosuppression in a case series of patients with NUSCC, and identify the distinguishing characteristics in this subgroup.


METHODS
Clinical, photographic and histological details were reviewed for all patients with NUSCC, over a 16-year period in a university dermatology department.


RESULTS
Forty-three patients were identified and seven (16%) were immunosuppressed. Patients with immunosuppression presented at a younger age (mean 52 vs. 63 years, P = 0.08) and sooner (mean 9 vs. 65 months, P < 0.001) than immunocompetent patients, and had a higher frequency of polydactylous disease [four of seven (57%) vs. two of 36 (6%), P < 0.001], relapse at the same site [two of seven (29%) vs. 0], and recurrent disease at other sites [four of seven (57%) vs. 0].


CONCLUSIONS
Immunosuppression plays a role in the development and clinical behaviour of NUSCCs. Clinicians should have a low threshold for early biopsy of nail dystrophies, particularly in those with immunosuppression. These patients are at higher risk of relapse and recurrent disease and therefore require prolonged follow-up.
Bristol Dermatology Centre, Bristol University Hospitals NHS Trust, Bristol Royal Infirmary, Bristol, BS2 8HW, U.K.
E
E
Ormerod
Bristol Dermatology Centre, Bristol University Hospitals NHS Trust, Bristol Royal Infirmary, Bristol, BS2 8HW, U.K.
D
D
de Berker
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000276:immunology*; D005260:Female; D006801:Humans; D007108:Immune Tolerance / Q000502:physiology*; D007121:Immunocompetence / Q000276:immunology; D007165:Immunosuppression Therapy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009260:Nail Diseases / Q000276:immunology*; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000276:immunology*; D055815:Young Adult