State of the Art Patient Evaluation and Treatment of Nail Unit Squamous Cell Carcinoma

The presentation discusses the state-of-the-art evaluation and treatment of nail unit squamous cell carcinoma (SCC), emphasizing the challenges and advancements in managing this rare condition. It distinguishes between surgical and non-surgical treatments, with surgical approaches being the standard of care. The literature reviewed highlights a lack of large patient series, typically involving limited case studies from tertiary care centers. This tumor is associated with high-risk HPV, leading to discussions on patient counseling and potential bone involvement in over 20% of cases. Surgical options like amputation are deemed effective but come with significant morbidity, urging clinicians to consider less invasive options like Mohs surgery or wide local excision which provide lower recurrence rates. The speaker underscores the importance of achieving clear surgical margins, particularly in complicated cases that may involve bone. Techniques used in Mohs surgery, such as excising tumors with the nail plate intact and addressing bone involvement directly, are highlighted as critical to optimize outcomes. The presentation concludes that understanding HPV association, tumor proximity to bone, and employing Mohs or wide local excision are key to effective treatment strategies for nail unit SCC.