From the Guidelines
Yes, a periungual wart can become cancerous, as it can be a presentation of squamous cell carcinoma in situ (SCC in situ) which can progress to invasive carcinoma 1, 2.
Key Points
- Periungual warts can present as hyperkeratotic, papillomatous or warty proliferations, and can be a sign of underlying SCC in situ 2.
- The presence of ulceration, bleeding, or a nodule is indicative of transformation to invasive carcinoma, which has a low metastasis rate of around 2% 2.
- Diagnosis can be delayed due to initial misdiagnosis as a benign lesion or delay in performing a biopsy, and repeat biopsies should be considered if the condition persists 2.
- Treatment options for periungual SCC include local excision, Mohs micrographic surgery, distal phalanx amputation, and radiotherapy, with a multidisciplinary approach to resection and reconstruction 1.
- HPV16 has been detected in periungual SCC in situ, highlighting the importance of diagnosis and treatment before progression to invasive carcinoma 1.
From the Research
Periungual Wart Malignant Transformation
- Periungual warts are generally caused by human papilloma virus (HPV) 1, 2, 4, 27, and 57, but HPV 16 and 18 are associated with malignant transformation to squamous cell carcinoma 3
- There have been reported cases of periungual and subungual warts undergoing malignant transformation into squamous cell carcinoma, with similar changes observed in multiple warts of other areas 4
- HPV-associated squamous cell carcinoma (SCC) and SCC in situ of the digits are often reported, with HPV16 being the most common subtype, and the tumors presenting as persistent verrucae 5
- Periungual and subungual warts caused by high-risk HPV subtypes pose a risk for malignant transformation in both immunocompetent and immunocompromised hosts 5
- The clinical appearance of digital HPV-associated SCCs or SCCs in situ is most commonly that of a periungual verruca, with tumors having a higher rate of recurrence after excision than SCC in other sites 5
Risk Factors and Treatment
- Immune suppression was documented in only 6.8% of patients with HPV-associated SCC and SCC in situ of the digits, suggesting that other factors may contribute to malignant transformation 5
- Treatment options for periungual warts include topical and intralesional therapies, systemic agents, and surgical procedures, with intralesional bleomycin appearing to be the most effective treatment 3
- Other treatment approaches, such as superficial x-ray therapy in combination with tretinoin, have also been employed to address periungual warts and associated soft tissue defects 6