Giuseppe COLLOCA, Luigi AZARIO, Patrizia CORNACCHIONE, Bruno FIONDA, Valentina LANCELLOTTA, Luca TAGLIAFERRI, Maria Antonietta GAMBACORTA, Giulia PANZA, Gian Carlo MATTIUCCI, Vincenzo VALENTINI

Subungual Squamous Cell Carcinoma of the Thumb Treated by “Function Sparing Approach” Using Contact Radiotherapy (Brachytherapy)

SUMMARYA-48-year old man, affected by HIV, working as an electrician, presented a swollen and painful subunguallesion over the distal phalanx of the right thumb with an important limitation to his job. A cutaneous examination of the right thumb revealed an irregular erosive crusted mass formation about 2 cm×1 cm sizewith erythematous changes and complete destruction of the overlying nail plate. There was no evidenceof regional lymphadenopathy; the patient was studied with computed tomography that did not show anydistant disease. A conservative onychectomy was performed with removal of the lesion and with histological confirmation of SCC. However, after five months, the patient presented local recurrence over thethumb. Amputation was proposed, but the patient declined due to the negative impacts on his job. Thus,contact radiotherapy (i.e., brachytherapy, BT) was proposed. BT was delivered using a customized homemade surface mold with six plastic tubes arranged around. The total delivered dose was 40 Gy delivered ineight fractions, 5 Gy for daily using Iridium-192 High Dose Rate (HDR) source. Four years later, recently,the patient is free from disease and has a complete functionality of the thumb without any limitations inany movement and in his job. The patient only reported a slight sensitivity reduction.

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