title: Surgical Treatment of Subungual Squamous Cell Carcinoma by Wide Excision of the Nail Unit and Skin Graft Reconstruction: An Evaluation of Treatment Efficiency and Outcomes.
abstract: The best surgical treatment modalities for subungual squamous cell carcinoma (SUSCC) without bone invasion need to be determined. The limited available data on Mohs micrographic surgery do not demonstrate its use as a standard procedure. A previous study in a limited series of patients has shown that wide surgical excision of the nail unit was associated with a low rate of recurrence.
  
  
  
  To confirm the efficiency of wide surgical excision of the nail unit with full-thickness skin graft reconstruction on a series of patients with SUSCC with an extended follow-up and to evaluate short- and long-term postoperative morbidity and patient satisfaction.
  
  
  
  A consecutive series of 55 patients with biopsy-proven SUSCC without bone invasion treated by wide surgical excision of the nail unit followed by full-thickness skin graft reconstruction from January 1, 2000, to August 31, 2012 were included. After a minimum follow-up of 5 years, the recurrences were collected from the referring physicians. Statistical analysis was conducted from January 1 to June 30, 2016.
  
  
  
  Demographic data, pathologic characteristics of tumors, postoperative follow-up, and recurrences were collected from medical records. Patients' satisfaction with surgery, quality of life, and delayed postoperative morbidity (functional outcome and sensory disorders) were assessed from a questionnaire mailed to patients and physicians.
  
  
  
  Among the 55 patients (23 women and 32 men; mean age, 64 years), the mean follow-up was 6.6 years (range, 5.0-11.2 years), with a minimum follow-up of 5 years. Fifty-two questionnaires (95%) were returned. Two recurrences were observed. Minor early postoperative complications, such as graft infection and delayed wound healing, were seen in 6 patients; 8 patients experienced severe pain. Late postoperative complications included hypersensitivity to mechanical shocks (39 of 51 patients [76%]), mildly increased sensitivity to cold (38 of 51 patients [75%]), loss of fine touch sensation (17 of 35 patients [49%]), and epidermal inclusion cysts (9 of 51 patients [18%]). Most patients were very satisfied with cosmetic and global outcomes of the surgery.
  
  
  
  Total excision of the nail unit followed by a full-thickness skin graft is a safe and efficient treatment for SUSCC without bone involvement, with satisfying cosmetic and functional outcomes.
authors.affiliation: Department of Dermatology, Centre Hospitalier Lyon Sud, Pierre-Bénite, France.
authors.forename: Solène
authors.initials: S
authors.lastname: Topin-Ruiz
authors.affiliation: Department of Dermatology, Centre Hospitalier Lyon Sud, Pierre-Bénite, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Surinach
authors.affiliation: Department of Dermatology, Centre Hospitalier Lyon Sud, Pierre-Bénite, France2Health Department, Université Claude Bernard Lyon 1, Lyon, France3Lyons Cancer Research Center, Lyon, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Dalle
authors.affiliation: Department of Biostatistics, Université Claude Bernard Lyon 1, Villeurbanne, France.
authors.forename: Gérard
authors.initials: G
authors.lastname: Duru
authors.affiliation: Department of Pathology, Centre Hospitalier Lyon Sud, Pierre-Bénite, France.
authors.forename: Brigitte
authors.initials: B
authors.lastname: Balme
authors.affiliation: Department of Dermatology, Centre Hospitalier Lyon Sud, Pierre-Bénite, France2Health Department, Université Claude Bernard Lyon 1, Lyon, France3Lyons Cancer Research Center, Lyon, France.
authors.forename: Luc
authors.initials: L
authors.lastname: Thomas
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009260:Nail Diseases / Q000473:pathology / Q000601:surgery*; D009262:Nails / Q000473:pathology / Q000601:surgery; D009364:Neoplasm Recurrence, Local; D017060:Patient Satisfaction; D011183:Postoperative Complications; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000473:pathology / Q000601:surgery*; D016038:Skin Transplantation / Q000379:methods*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome