Abstract: A 49 y.o Caucasian man with h/o HTN presented with a non-traumatic moderate throbbing pain of the right thumb for the past 3 weeks. He previously presented to urgent care where he was treated for paronychia with topical antibiotics and warm soaks. On physical exam, he was afebrile, with an erythematous swollen lesion at the root of the nail. Due to failure of the prior treatment, he was started on oral antistaphyloccocal antibiotics for a total of 3 weeks. Imaging of the right thumb ruled out osteomyelitis. Upon follow-up, a partial avulsion was performed for then suspected ingrown nail. Despite this last procedure, the non-healing lesion worsened, easily bleeding to contact. A biopsy was performed. Pathology came back positive for invasive SCC. There was no history of prior chronic lesion on this patient’s thumb, and the only risk factor was a sun-exposed area on fair skin. The worsening of a chronic lesion despite a long course of antibiotic should trigger the suspicion of a malignant process. This case illustrates the need for a biopsy in a non-healing lesion which can masquerade a neoplastic process. Squamous cell carcinoma (SCC) is the second most common cancer of the skin. It’s a malignancy that can occur in any surface of the skin. In fair-skin individuals, the most common locations are the ones exposed to the sun. The clinical findings can vary based on the location and type of lesion. Chronic wounds, chronic inflammations, scarring, non-healing ulcers can be a manifestation of SCC.Summary: Cutaneous squamous cell carcinoma is a malignant tumor arising from epidermal keratinocytes. After basal cell carcinoma, it's the second most common cancer of the skin. it's a malignancy that can occur in any place of the skin. It presents with a wide variety of cutaneous lesions. In fair-skinned individuals, SCC most commonly arise in site frequently exposed to the sun especially to ionizing or UV radiation.
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