Abstract
Squamous cell carcinoma (SCC) of the nail unit is a rare but highly treatable malignancy. A tissue biopsy is recommended to establish the diagnosis and guide treatment. Mohs surgery is the standard of care to preserve tissue and function for early SCC. The authors report a 76-year-old patient with a very advanced and neglected SCC of the nail unit that grossly extended to the middle phalanx. No prior reports of such an extensive growth have been documented. Due to extensive skin and bone involvement, we proceeded with amputation at the level of the proximal phalanx to obtain negative margins. We achieved a tumor-free status with a well-healed stump at 1-year follow-up. The diagnostic workup should include a multidisciplinary approach with assessment of locoregional and distant spread and exclusion of atypical infections or metastatic disease. Amputation should be performed when there is extensive tissue and bone involvement.