nail bed tolerance

[RickyScott]

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does anyone know the late tolerance of nail bed to xrt, at what dose nail will not regrow?
I have subungal basal cell

 

[communitydoc13]

does anyone know the late tolerance of nail bed to xrt, at what dose nail will not regrow?
I have subungal basal cell

Meh...I say don't worry about it. That nail will never be right. Doesn't mean digit won't be functional, growth will not occur and patient will be pain free.

Consent for the nail being gone.

 

[RickyScott]

agreed, just was curious if anyone has experience

 

[TheWallnerus]

does anyone know the late tolerance of nail bed to xrt, at what dose nail will not regrow?
I have subungal basal cell

I have treated subungual warts to 30 Gy/12 fx. 100% cure rate. Nail drops off. Always regrows by 6 months. However I am not sure this anecdote helps you 🙂

 

[taserlaser]

non RT answer is I refer these pts for Mohs for this reason. That being said I have not yet endeavoured to find this answer and am curious to responses

 

[RadOncMegatron]

I have treated subungual warts to 30 Gy/12 fx. 100% cure rate. Nail drops off. Always regrows by 6 months. However I am not sure this anecdote helps you 🙂

Really? That is cool. I’ve never heard of such a thing.

 

[TheWallnerus]

Really? That is cool. I’ve never heard of such a thing.

RT has an about 100% cure rate for warts. I have treated several. Warts can really be pretty serious and bothersome in very rare instances. I suppose the biology is not far off from an HPV induced pre neoplasm, and HPV seems to make a cell more radiosensitive, so RT being the bane of a wart’s existence makes sense to me. RT in derms’ offices for warts was definitely a thing in the 1970s era and prior.

 

[RickyScott]

RT has an about 100% cure rate for warts. I have treated several. Warts can really be pretty serious and bothersome in very rare instances. I suppose the biology is not far off from an HPV induced pre neoplasm, and HPV seems to make a cell more radiosensitive, so RT being the bane of a wart’s existence makes sense to me. RT in derms’ offices for warts was definitely a thing in the 1970s era and prior.

i once radiated massive condylomas wrapping around perineum in setting of HIV with dramatic response.

 

[RickyScott]

non RT answer is I refer these pts for Mohs for this reason. That being said I have not yet endeavoured to find this answer and am curious to responses

pt doesnt want to undego painful removal of fingernail and then surgery

 

[taserlaser]

pt doesnt want to undego painful removal of fingernail and then surgery

also a fair reason for RT I’ll give you that

 

[pikachu]

i once radiated massive condylomas wrapping around perineum in setting of HIV with dramatic response.

Have seen similar in pt with co-occurring giant condyloma and invasive SCC. Couple case reports out there too

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11041860/

 

[radoncftw]

data on this would be helpful.
I got a referral from a mohs surgeon for a distal finger SCC of the skin extending near the nail bed.
I couldn't reliably tell the patient what would happen to the nail bed with 60Gy or higher
He used his hands/digits alot for their profession.
ended up getting Mohs

 

[CaesarRO]

i once radiated massive condylomas wrapping around perineum in setting of HIV with dramatic response.

Saw a case like this in residency, but my attending was too chicken. What dose did you use?

 

[RickyScott]

Saw a case like this in residency, but my attending was too chicken. What dose did you use?

VMAT to 50 Gy. These were massive condyloma that patient had to push aside in order to defecate. he couldnt even sit down.