Digital squamous cell carcinoma

55 Digital squamous cell carcinoma




INITIAL PRESENTATION


Hind limb lameness and a subungual nodule in an English setter.



INTRODUCTION


Nodular lesions of the nail bed may be the result of an inflammatory process, usually with a pyogranulomatous infiltrate, or neoplasia. Squamous cell carcinoma, mast cell tumour and melanoma are three of the more common tumours affecting the nail beds. This case report describes a case of squamous cell carcinoma of the nail bed that was treated by digital amputation.




CASE PRESENTING SIGNS


A 9-year-old, entire female English setter was presented with left hind limb lameness.



CASE HISTORY



• An initial weight-bearing lameness had been noted 1 week previously.

• The patient was now reluctant to bear any weight on the left hind limb and had been licking at the foot.

• There was no history of a previous traumatic wound or foreign body penetration, and no previous history of skin disease or symptoms suggestive of systemic involvement.

• The patient had been annually vaccinated and regularly wormed.

• There were no other animals in the household and no evidence of zoonosis.


CLINICAL EXAMINATION



• General physical examination was unremarkable.

• A 1-cm-diameter, nodular mass with an ulcerated and exudative surface was located subungually on the second digit of the left hind foot (Figs 55.1 and 55.2).

• The digit was swollen and painful, and a purulent discharge exuded from the nail fold and the margins of the mass. The nail was deformed.

• There was left popliteal lymphadenopathy.

image

Figure 55.1 Ulcerated nodule with purulent exudation and nail deformity.


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Figure 55.2 Ulcerated nodule with purulent exudation and nail deformity.




DIFFERENTIAL DIAGNOSES


The principal differential diagnoses for a subungual mass are neoplasia or a granulomatous inflammatory lesion. The differential diagnoses included:



• Neoplasia
• Squamous cell carcinoma

• Mast cell tumour

• Malignant melanoma

• Granulomatous inflammation
• Bacterial or fungal infection

• Penetrating foreign body.


CASE WORK-UP


Cytological examination of fine-needle aspirates of the mass and also of draining lymph nodes is indicated in nodular diseases. Radiography of the foot can be helpful in identifying foreign bodies and bone lysis that may be evident in neoplastic disease. In suspected neoplasia, survey chest and abdominal radiographs are indicated to look for evidence of metastasis.


The patient was sedated with a combination of medetomidine and butorphanol, and the following diagnostic tests performed:


• Cytological examination of a surface impression smear revealed many neutrophils and a mixed population of bacteria with both rods and cocci evident.

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Sep 3, 2016 | Posted by in SMALL ANIMAL | Comments Off on Digital squamous cell carcinoma

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