BACKGROUND. A case of subungual squamous cell carcinoma, which is a rare malignancy and has an elusive etiology, is reported. OBJECTIVE. To present radiation therapy as a viable treatment option to amputation for surgically unresectable subungual squamous cell cancer. METHODS. A 69-year-old man with a 16-year-old history of subungual squamous cell carcinoma of the left thumb was treated by external beam radiation therapy. In this case, bone invasion precluded the patient from successfully completing Moh's micrographic surgery. RESULTS. The treated thumb at 17 months after radiation therapy remained tumor free. CONCLUSION. Radiation therapy should be considered a treatment option for nail bed squamous cell carcinoma before considering amputation and perhaps as salvage for all unresectable lesions.
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