E-Case for Diagnosis
A Refractory Periungual Lesion
Lesión periungueal resistente a tratamiento
J. Boix-Vilanova
, N. Izquierdo-Herce, L.J. del Pozo
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Servicio de Dermatología, Hospital Universitari Son Espases, Palma de Mallorca, Islas Baleares, Spain
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Boix-Vilanova, N. Izquierdo-Herce, L.J. del Pozo" "autores" => array:3 [ 0 => array:4 [ "nombre" => "J." "apellidos" => "Boix-Vilanova" "email" => array:1 [ 0 => "julian.boix@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "N." "apellidos" => "Izquierdo-Herce" ] 2 => array:2 [ "nombre" => "L.J." "apellidos" => "del Pozo" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Hospital Universitari Son Espases, Palma de Mallorca, Islas Baleares, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Lesión periungueal resistente a tratamiento" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 975 "Ancho" => 650 "Tamanyo" => 65757 ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Case History</span><p id="par0005" class="elsevierStylePara elsevierViewall">An 87-year-old man with no relevant medical history sought care for an asymptomatic 2-month-old lesion on the first toe of his right foot. Paronychia was first suspected and a topical antibiotic was prescribed. When the lesion did not respond, a biopsy was performed to rule out Bowen disease.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Physical Examination</span><p id="par0010" class="elsevierStylePara elsevierViewall">An erythematous, scaly plaque was found proximal to the nail fold of the first toe. There were small points of erosion and crusts on the surface (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Histopathology</span><p id="par0015" class="elsevierStylePara elsevierViewall">Histology demonstrated several points of proliferation of basaloid cells in the papillary dermis and a retracted stroma. The adjacent dermis contained an infiltrate of lymphocytes and histiocytes (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">What Is Your Diagnosis?</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Diagnosis</span><p id="par0025" class="elsevierStylePara elsevierViewall">The definitive diagnosis was multifocal basal cell carcinoma (BCC).</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Clinical Course and Treatment</span><p id="par0030" class="elsevierStylePara elsevierViewall">The BCC was excised by deferred Mohs surgery, and the defect was reconstructed using a partial skin graft (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Comment</span><p id="par0035" class="elsevierStylePara elsevierViewall">BCCs, which are usually found on the head and trunk, are seen less often on the dorsal surface of the hands and even less often on the dorsal surface of the feet.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> The pathogenesis of BCC is complex and many risk factors have been described, among them exposure to UV light.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> One theory holds that the number of sebaceous glands per square millimeter of skin is relevant. This theory has been invoked to account for a higher incidence of BCC on areas of the face where more of these glands are located (beard, cheeks, nose, or forehead) and where UV light exposure is also high.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> The incidence is much lower in areas where there are fewer sebaceous glands such as the dorsal surface of the foot.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Only 17 cases of BCC have been reported on the dorsum of the foot. Eleven of the 17 were on the toes and all 11 involved the nail or surrounding skin.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2,4</span></a> A possible explanation for this finding would be a common embryonic origin of the nail matrix and hair follicles, which would theoretically give rise to cells of the pilosebaceous units.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">BCCs involving the nail such as we saw in this case have sometimes been treated with micrographic Mohs surgery, which better preserves the tissue and function of the toe while also guaranteeing complete excision of the tumor.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2,4,6</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">We wish to emphasize that BCCs are rare in acral locations, that refractory lesions should be biopsied, and that Mohs surgery is indicated when carcinoma affects the nail.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conflicts of Interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:8 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Case History" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Physical Examination" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Histopathology" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Diagnosis" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Clinical Course and Treatment" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Comment" ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflicts of Interest" ] 7 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-05-28" "fechaAceptado" => "2017-10-07" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Boix-Vilanova J, Izquierdo-Herce N, del Pozo LJ. A Refractory Periungual Lesion. Actas Dermosifiliogr. 2019;110:e9–e10.</p>" ] ] "multimedia" => array:3 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 445 "Ancho" => 650 "Tamanyo" => 33519 ] ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 489 "Ancho" => 650 "Tamanyo" => 141929 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin-eosin, ×10.</p>" ] ] 2 => array:6 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 975 "Ancho" => 650 "Tamanyo" => 65757 ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Variations of basal cell carcinomas according to gender, age, location and histopathological subtype" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "Y. 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| 2024 Junio | 64 | 33 | 97 |
| 2024 Mayo | 62 | 33 | 95 |
| 2024 Abril | 87 | 28 | 115 |
| 2024 Marzo | 72 | 30 | 102 |
| 2024 Febrero | 67 | 39 | 106 |
| 2024 Enero | 58 | 29 | 87 |
| 2023 Diciembre | 60 | 19 | 79 |
| 2023 Noviembre | 73 | 31 | 104 |
| 2023 Octubre | 64 | 30 | 94 |
| 2023 Septiembre | 45 | 29 | 74 |
| 2023 Agosto | 42 | 14 | 56 |
| 2023 Julio | 58 | 44 | 102 |
| 2023 Junio | 36 | 18 | 54 |
| 2023 Mayo | 49 | 20 | 69 |
| 2023 Abril | 41 | 18 | 59 |
| 2023 Marzo | 47 | 12 | 59 |
| 2023 Febrero | 61 | 23 | 84 |
| 2023 Enero | 35 | 18 | 53 |
| 2022 Diciembre | 41 | 37 | 78 |
| 2022 Noviembre | 54 | 33 | 87 |
| 2022 Octubre | 49 | 22 | 71 |
| 2022 Septiembre | 84 | 29 | 113 |
| 2022 Agosto | 75 | 33 | 108 |
| 2022 Julio | 57 | 32 | 89 |
| 2022 Junio | 34 | 33 | 67 |
| 2022 Mayo | 34 | 36 | 70 |
| 2022 Abril | 33 | 21 | 54 |
| 2022 Marzo | 39 | 51 | 90 |
| 2022 Febrero | 29 | 22 | 51 |
| 2022 Enero | 35 | 40 | 75 |
| 2021 Diciembre | 38 | 35 | 73 |
| 2021 Noviembre | 27 | 37 | 64 |
| 2021 Octubre | 34 | 48 | 82 |
| 2021 Septiembre | 31 | 48 | 79 |
| 2021 Agosto | 40 | 23 | 63 |
| 2021 Julio | 43 | 24 | 67 |
| 2021 Junio | 19 | 25 | 44 |
| 2021 Mayo | 41 | 39 | 80 |
| 2021 Abril | 90 | 52 | 142 |
| 2021 Marzo | 43 | 20 | 63 |
| 2021 Febrero | 42 | 25 | 67 |
| 2021 Enero | 18 | 11 | 29 |
| 2020 Diciembre | 22 | 15 | 37 |
| 2020 Noviembre | 20 | 16 | 36 |
| 2020 Octubre | 18 | 12 | 30 |
| 2020 Septiembre | 37 | 10 | 47 |
| 2020 Agosto | 20 | 19 | 39 |
| 2020 Julio | 15 | 11 | 26 |
| 2020 Junio | 29 | 21 | 50 |
| 2020 Mayo | 16 | 15 | 31 |
| 2020 Abril | 19 | 15 | 34 |
| 2020 Marzo | 19 | 6 | 25 |
| 2020 Febrero | 4 | 0 | 4 |
| 2019 Mayo | 2 | 0 | 2 |
| 2019 Marzo | 1 | 2 | 3 |
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