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Maligne Tumoren des Nagelorgans

Malignant nail tumors

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Zusammenfassung

Entsprechend den unterschiedlichen Geweben, die das Endglied von Fingern und Zehen aufbauen, gibt es sehr viele verschiedene Tumoren. Am häufigsten ist der Morbus Bowen, der meist als verruköse Veränderung bei Personen ab dem Alter von 40 Jahren auftritt. Hauptlokalisationen sind der laterale Nagelwall und das Nagelbett. Nach jahre- bis jahrzehntelangem Bestand ist der Übergang in ein invasives Plattenepithelkarzinom möglich. Dieses kann sich aber auch primär subungual entwickeln, meist als Onycholyse mit Nässen. Der zweithäufigste maligne Nageltumor ist das Melanom. Wenn es von der Matrix ausgeht, ist es meist pigmentiert, während Nagelbettmelanome überwiegend amelanotisch sind und oft als Unguis incarnatus bei älteren Personen imponieren. Therapie der Wahl ist bei in situ und früh invasiven Melanomen die großzügige Lokalexzision unter Erhalt der Endphalanx. Amputation ist nur bei fortgeschrittenen Melanomen indiziert. Neben den beiden häufigen ungualen Malignomen gibt es selten nagelspezifische Karzinome, maligne Gefäß- und Knochentumoren sowie andere Sarkome, Beteiligung im Rahmen von malignen Systemerkrankungen und Metastasen. Sie lassen sich in der Mehrzahl der Fälle nicht klinisch eindeutig diagnostizieren. Trotzdem muss an einen malignen Tumor gedacht werden bei allen umschriebenen, auf konservative Therapie nicht ansprechenden Nagelprozessen.

Abstract

Because of the large number of different tissues making up the distal phalanx of fingers and toes, a large variety of malignant tumors can be found in and around the nail apparatus. Bowen disease is probably the most frequent nail malignancy. It is usually seen as a verrucous plaque of the nail fold and nail bed in persons above the age of 40 years. It slowly grows over a period of years or even decades before degenerating to an invasive squamous cell carcinoma. The latter may also occur primarily often as a weeping onycholysis. The next most frequent nail malignancy is ungual melanoma. Those arising from the matrix are usually pigmented and often start with a longitudinal melanonychia whereas those originating from the nail bed remain amelanotic, are often nodular and mistaken for an ingrown nail in an elderly person. The treatment of choice for in situ and early invasive subungual melanomas is generous extirpation of the nail apparatus whereas distal amputation is only indicated for advanced melanomas. In addition to these frequent nail malignancies, nail-specific carcinomas, malignant vascular and osseous tumors, other sarcomas, nail involvement in malignant systemic disorders and metastases may occur. In most cases, they cannot be diagnosed accurately on clinical grounds. Therefore, a high degree of suspicion is necessary in all isolated or single-digit proliferations that do not respond to conservative treatment.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. E. Haneke gibt an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Dermaticum Freiburg, Schlippehof 5, 79110, Freiburg, Deutschland

    E. Haneke

  2. Dermatol Klinik Inselspital, Univ. Bern, Bern, Schweiz

    E. Haneke

  3. Centro Dermatol Epidermis, Porto, Portugal

    E. Haneke

  4. Kliniek voor Huidziekten, Academisch Ziekenhuis, Univ. Gent, Gent, Belgien

    E. Haneke

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Haneke, E. Maligne Tumoren des Nagelorgans. Hautarzt 65, 312–320 (2014). https://doi.org/10.1007/s00105-013-2705-z

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