A 46-year-old white female was referred from the dermatology clinic with a biopsy-proven squamous cell carcinoma of the left ring finger perionychium. Physical examination demonstrated erythematous scaly lesions with the absence of a nail plate at the left thumb, index finger, and ring finger as well as the right long finger, without associated lymphadenopathy (Fig ). She described chronic onychomycosis of the nails attributed to her job as a dishwasher.\nPast medical history was significant for chronic onychomycosis. Social history demonstrated a 40 pack-year smoking habit. She denied alcohol use, exposure to aniline dyes, radiation, or arsenic exposure.\nThe decision was made to biopsy all digits with scaly lesions. She was advised to stop smoking and counseled about the likely need for partial amputation. Pathology demonstrated squamous cell carcinoma of all biopsy sites. Wide local excision with partial amputation was performed on all involved digits with preservation of the left thumb interphalangeal joint and left index finger, left ring finger, and right long finger proximal interphalangeal (Fig ).\nSurgical pathology demonstrated positive margins on the left thumb and left ring finger necessitating reexcision. All final margins are clear and all incisions have healed nicely (Fig ).\nDue to the extensive nature of the patients' cancer and longstanding history, we elected to perform amputation as opposed to other treatment modalities, which will be described further in the discussion. The patient is currently about 1 year out from surgery and has returned to normal activities and displays no evidence of recurrence.
Case 5. A 78-year-old female presented with a 4-month history of a crusted nail bed lesion and nail plate dystrophy of the right index finger; there was no axillary lymphadenopathy. She also suffered from type 2 diabetes, gout and hypertension. Histology revealed a moderately differentiated SCC arising from bowenoid dysplasia. Following MDT discussion, she underwent right index finger amputation through the DIPJ using a volar skin flap for coverage under local anaesthetic. The 2.3 mm thick SCC was completely excised however Bowen's disease was present at the lateral margin and was therefore treated topically. She has had no sign of recurrence or metastasis for 14 months.