Subungual Verrucous Carcinoma of the Thumb Treated by Intra-arterial Infusion with Methotrexate

Abstract

Background For preservation of integrity of appearance and function in a 66-year-old male with an extremely rare case of verrucous carcinoma developing from the subungium of his right thumb, intra-arterial infusion with methotrexate was used. Objective To evaluate the effectiveness of arterial infusion with methotrexate in this unusual nail bed cancer. Methods Right brachial arterial catheterization and infusion with methotrexate (50 mg) were used every 24 hours together with simultaneous intramuscular injection of 6 mg of leucovorin every 6 hours for 10 days. Results At 4 years, 8 months after therapy, the patient was in sustained complete remission with a functionally normal right thumb. Conclusion This case study suggests that intra-arterial infusion chemotherapy is a simple and effective method for thumb subungual verrucous carcinoma with the unique advantage of preservation of morphology and functional conditions. It can be considered an effective treatment option.