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Introduction:Discoid lupus erythematosus can affect periungual tissues leading to onychodystrophy. Squamous cell carcinoma can occur in persistent scars of discoid lupus; this rare occurrence has not yet been reported on the nail unit. Case presentation: we report a case of squamous cell carcinoma occurring on the distal phalanx of the thumb in a patient with longstanding periungual discoid lupus on several fingernails. Discussion:Periungual discoid lupus erythematosus is rare. The scars caused by this disease can very rarely develop into squamous cell carcinoma. This is the first report of this occurrence at the periungual tissues.

Background:The lesions of porokeratosis (PK) lead to skin atrophy and scarring as long as they spread centrifugally. PK affecting the nail unit is seldom described. Objective:The aim was to revise the previously reported cases of ungual PK and to present 3 new cases. Methods:A PubMed search was performed with the keywords “nail” and “porokeratosis.” Previously reported cases as well as 3 new cases are depicted in tables. Results:Only 11 cases of ungual PK were found; 3 new cases have been added. All patients presented with typical lesions of PK (Mibelli, isolated, segmental, or ostial eccrine types) that happened to affect nails due to nail matrix or nail bed compromise, resulting in mild to severe nail scarring, including irreversible anonychia. The present 3 case series contrast with the previous single case reports. Conclusions:PK affecting the nails is exceedingly rare. Changes in nails affected by PK are irreversible, since, as on the skin, this is a chronic scarring process.

Background:Lichen planus (LP) can lead to severe scarring of the nail unit leading to anonychia. There are very few reports of squamous cell carcinoma (SCC) occurring in the lesions of ungual LP. Objective:The aim of this study was to revise the previously reported cases of SCC appearing in ungual LP and to present a new case. Methods:A PubMed search was performed with the terms “nail lichen planus” and “squamous cell carcinoma.” Reported cases as well as a new case were depicted in a table. Results:Only 2 indexed articles reporting 3 cases were found. All patients suffered of long-lasting scarring ungual LP. Conclusions:The occurrence of SCC in nail LP is rare. LP is not “premalignant” per se, but SCC might rarely arise in LP scars.

Background:Nail apparatus melanoma (NAM) is rare. The higher mortality reported in the literature is most likely due to advanced disease associated with delayed diagnosis and treatment. Objective:All patients diagnosed with NAM were followed at a single reference center during a period of 10 years, with emphasis on dermatological and histological findings. Clinical outcomes were included. Methods:A retrospective review of medical records, photographs, and histopathological examination. Results:73.7% of the patients were female and their mean age was 47 years. Caucasian and African-American patients had a similar incidence (47.4%). There was only 1 Asian patient in this study (5.3%). All patients presented with nail plate pigmentation. The mean prediagnosis duration was 33 months. A total of 63.2% patients had in situ melanoma and an average Breslow index of 2.18 mm in invasive cases. Fifteen patients underwent conservative surgery and 3 underwent phalanx amputation. All patients survived, and 4 have had more than a 5-year follow-up. Conclusion:In situ lesions showed longitudinal bands or total melanonychia with no nail dystrophy. Invasive cases presented with dystrophic lesions (longitudinal splitting of the nail). Conservative surgery provides a good option without worsening the prognosis. All dermatologists should be aware of early signs of NAM, since prognosis depends on early treatment.

The most commonly seen nail change in sarcoidosis, often associated with chronic systemic disease, is onychodystrophy. Imaging of hands, feet and chest is of paramount importance when nail sarcoidosis is suspected, for evaluation of bone cysts and pulmonary involvement, respectively. We report 2 cases of sarcoidosis that developed nail involvement - one with pulmonary disease, and the other without any evidence of systemic involvement, which is very rare.