Elsevier

Dermatologic Clinics

Volume 24, Issue 3, July 2006, Pages 297-311
Dermatologic Clinics

Common Nail Tumors

https://doi.org/10.1016/j.det.2006.03.002Get rights and content

Section snippets

Warts

Common warts are caused by human papilloma viruses (HPV) of different DNA types. They are benign, weakly contagious, fibroepithelial tumors with a rough keratotic surface. Most frequently, they are located on the lateral aspect of the proximal nail fold and spread across the dorsum of the entire fold (Fig. 1). Tender nodules beneath the proximal nail fold are infrequent [1], [2], [3], [4] and rarely result in longitudinal grooving. Subungual warts initially affect the hyponychium, growing

Distal digital keratoacanthoma

Subungual and periungual keratoacanthoma may occur as solitary or multiple tumors [9], [10]. They are rare, benign but rapidly growing, and seemingly aggressive, tumors usually situated below the edge of the nail plate or in the most distal portion of the nail bed. Multiple subungual keratoacanthomas without keratoacanthomas on other sites are exceptional [11]. The distal phalanx of the toe was affected in three cases. Spontaneous resolution is rare [12].

The lesion may start as a small and

Onychomatricoma

Onychomatricoma, a condition described 25 years ago [22], [23], has been reported in several countries [24], [25], [26], [27], [28]. Three main clinical signs are striking enough to make the diagnosis or at least to arouse suspicion of this condition:

  • 1.

    There is a yellow longitudinal band of variable width, leaving a single or double portion of normal pink nail on either side. Splinter hemorrhages may be seen in the yellow area involving the proximal nail region in a characteristic manner.

Koenen's tumors

Koenen's periungual fibromas develop in about 50% of the cases of tuberous sclerosis (epiloia or Bourneville-Pringle disease), which is a dominantly inherited multisystem disease affecting the central nervous system, eyes, skin, cutaneous appendages, kidneys, heart, blood vessels, and bones. Two major gene loci have been identified where mutations can cause the tuberous sclerosis complex with apparently indistinguishable phenotypes: TSC1 at 9q34 and TSC2 at 16p13.3 [35]. The periungual fibromas

Acquired ungual fibrokeratoma

Acquired ungual fibrokeratoma probably is a variant of acquired digital fibrokeratoma [42] and garlic clove fibroma [43]. Classically, they are acquired, benign, spontaneously developing, asymptomatic nodules with a hyperkeratotic tip and a narrow base. They occur mostly in the periungual area or elsewhere on the fingers. They may double or even triple and may reach a considerable size. Most ungual fibrokeratomas emerge from beneath the proximal nail fold, growing on the dorsum of the nail

Exostosis and osteochondroma

Subungual exostoses are not true tumors but rather are outgrowths of normal bone or calcified cartilaginous remains. Whether or not subungual osteochondroma [48] is a different entity is still not clear [49]. Subungual exostoses are rarely reported. There were only 60 subungual exostoses in a series of 6034 benign osseous lesions [50]; however, they may be considerably underdiagnosed and underreported. Exostoses are bony growths that are painful on pressure and may elevate the nail (Fig. 6).

Pyogenic granuloma

Pyogenic granuloma is a benign, eruptive hemangioma resulting from minor, penetrating skin injury. It starts around the nail as a minute, red papule that rapidly grows to the size of a pea or even a cherry. Its surface may become eroded by necrosis of the overlying epidermis. Crusting may mimic a malignant melanoma, although the typical collarette can usually be seen. Pyogenic granuloma commonly is located at the proximal nail fold but may develop distally in the hyponychium region (Fig. 7) or

Glomus tumor

Approximately 75% of glomus tumors occur in the hand, especially in the fingertips and in particular in the subungual area. One percent to 2% of all hand tumors are glomus tumors [67]. The age of patients at the time of diagnosis ranges from 30 to 50 years. Men are less frequently affected than women. Seven cases of subungual glomus tumors have been reported in von Recklinghausen's neurofibromatosis [68].

The glomus tumor is characterized by intense, often pulsating pain that may be spontaneous

Giant cell tumor

Giant cell tumor is a neoplasm derived from the tendon sheath or the joint synovium. It is the second most common subcutaneous tumor of the hand. It is more frequent in females than in males. On the digits, it usually occurs on the dorsum of the distal interphalangeal joint and appears as a solitary, often lobulated, slow-growing, skin colored, and smooth-surfaced nodule that tends to feel firm and rubbery (Fig. 9). The tumor may enlarge to the size of a cherry and may cause pain on flexion by

Bowen's disease

Bowen's disease, the first recognized example of carcinoma in situ, is a nonaggressive malignant condition that has attracted interest for several reasons:

  • 1.

    There is increased awareness of its frequency because of numerous recent reports in the literature.

  • 2.

    New clinical patterns have been identified.

  • 3.

    The process is potentially polydactylous with the passage of time.

  • 4.

    A proven link with the HPV sheds new light on the etiology of this type of cancer.

Bowen's disease of the nail apparatus is a distinctive

First page preview

First page preview
Click to open first page preview

References (133)

  • A.C. Rettig et al.

    Glomus tumor of the digits

    J Hand Surg

    (1977)
  • S. Sawada et al.

    Three cases of subungual glomus tumors with von Recklinghausen neurofibromatosis

    J Am Acad Dermatol

    (1995)
  • E.M. Corrado et al.

    Thermographic diagnosis of glomus tumour

    Hand

    (1982)
  • J. Van Geertruyden et al.

    Glomus tumours of the hand. A retrospective study of 51 cases

    J Hand Surg

    (1996)
  • B. Richert et al.

    Latero-subungual giant cell tumor of the tendon sheath: an unusual location

    J Am Acad Dermatol

    (1999)
  • R. Baran et al.

    Longitudinal melanonychia: a symptom of Bowen's disease

    J Am Acad Dermatol

    (1988)
  • U. Sass et al.

    Longitudinal melanonychia revealing an intraepidermal carcinoma of the nail apparatus: detection of integrated HPV-16 DNA

    J Am Acad Dermatol

    (1998)
  • R. Baran et al.

    Polydactylous Bowen's disease of the nail

    J Am Acad Dermatol

    (1987)
  • T.T. Holland et al.

    Tender periungual nodules

    Arch Dermatol

    (1992)
  • S. Lauchli et al.

    Swelling of the proximal nail fold caused by underlying warts

    Dermatol

    (2001)
  • B. Kumar et al.

    Phalangeal erosions with subungual warts

    Indian J Dermatol Venereol

    (1980)
  • G. Plewig et al.

    Mutilierende subunguale Warzen: Abheilung durch Methotrexat

    Hautarzt

    (1973)
  • U.R. Hengge et al.

    Self-administered topical 5% imiquimod for the treatment of common warts and mollusca contagiosa

  • W.B. Shelley et al.

    Intralesional bleomycin sulfate therapy for warts: a novel bifurcated needle puncture technique

    Arch Dermatol

    (1991)
  • B.S. Ross et al.

    Pulsed dye laser treatment for warts: an update

    Dermatol Surg

    (1999)
  • R. Baran et al.

    Distal digital keratoacanthoma: a report of 12 cases and review of the literature

    Br J Dermatol

    (1998)
  • R. Baran et al.

    Distal digital keratoacanthoma. Two cases with a review of the literature

    Dermatol Surg

    (2001)
  • Haneke E. Multiple subungual keratoacanthomas. XII International Congress of Dermatologic Surgeons, Munich, Germany....
  • A. Sinha et al.

    Spontaneous regression of subungual keratoacanthoma with reossification of underlying distal lytic phalanx

    Clin Exp Dermatol

    (2005)
  • J.L. Drapé et al.

    Ultrasonography and magnetic resonance imaging of the perionychium

  • P. Scarini et al.

    Subungual keratoacanthoma. A variant of verrucous squamous cell carcinoma of the skin

    Appl Pathol

    (1983)
  • K. Yoshikawa et al.

    A case of eruptive keratoacanthoma treated by oral etretinate

    Br J Dermatol

    (1985)
  • V. Voigtländer et al.

    Destruierendes subunguales Keratoakanthom: Erhaltung der Endphalanx durch kombinierte operative und medikamentöse Therapie

    Z Hautkr

    (1990)
  • R. Bennet et al.

    Current management of keratoacanthoma using 5-FU

    Cutis

    (1985)
  • S. Sayama et al.

    Treatment of keratoacanthoma with intralesional bleomycin

    Br J Dermatol

    (1983)
  • R. Baran et al.

    Surgical treatment of a filamentous tufted tumour in the matrix of a funnel-shaped nail—a new entity

    Z Haut Geschlechtskr

    (1991)
  • R. Baran et al.

    Onychomatricoma. Filamentous tufted tumour in the matrix of a funnel-shaped nail: a new entity

    Br J Dermatol

    (1992)
  • C. Van Holder et al.

    Onychomatricoma

    J Hand Surg

    (1999)
  • G.R. Fraga et al.

    Onychomatricoma. Report of a case and its comparison with fibrokeratoma of the nail bed

    Am J Dermatopathol

    (2001)
  • S. Nagamatsu et al.

    A case of onychomatricoma

    Japanese Journal of Plastic Reconstructive Surgery

    (2002)
  • C. Laxmisha et al.

    Onychomatricoma

    Indian J Dermatol

    (2003)
  • C.J. Ko et al.

    Ungioblastoma and unguioblastic fibroma—an expanded spectrum of onychomatricoma

    J Cutan Pathol

    (2004)
  • N. Raison-Peyron et al.

    Onychomatricoma: an unusual cause of nail bleeding

    Clin Exp Dermatol

    (1998)
  • J. Fayol et al.

    Onychomatricoma with misleading features

    Acta Derm Venereol

    (2000)
  • S. Goettmann et al.

    Onychomatricome: 3 nouveaux cas, intérêt de la résonance magnétique nucléaire

    Ann Dermatol Venereol

    (1994)
  • E. Haneke et al.

    Onychomatricoma

    Dermatol Surg

    (1995)
  • A. Kint et al.

    The onychomatricoma: an electron microscopic study

    J Cutan Pathol

    (1997)
  • J.R. Sampson et al.

    The molecular genetics of tuberous sclerosis

    Hum Mol Genet

    (1994)
  • D.W. Webb et al.

    The cutaneous features of tuberous sclerosis: a population study

    Br J Dermatol

    (1996)
  • E. Haneke

    Intraoperative differential diagnosis of onychomatricoma, Koenen's tumours, and hyperplastic Bowen's disease. 7th Congress of the European Academy of Dermatology and Venereology–European Nail Society, Nice, 1998

    J Eur Acad Dermatol Venereol

    (1998)
  • Cited by (46)

    • Nail Tumors

      2021, Dermatologic Clinics
      Citation Excerpt :

      Glomus tumors typically present with highly localized pain on pressure in the precise location of the tumor, which is describes as a positive Love sign. Hildreth sign, which restricts blood flow using an inflatable blood pressure cuff, is positive if it relieves the pain of pressure on the glomus tumor.22 Most glomus tumors result in pain on pressure and sensitivity to cold, findings which are highly specific to glomus tumors.

    • Nail tumors

      2013, Clinics in Dermatology
    • Nail histopathology

      2013, Actas Dermo-Sifiliograficas
      Citation Excerpt :

      When the changes are more subtle, histochemical staining should be performed with benzidine to reveal the presence of hemoglobin (Perls stain is not appropriate for use on the nail apparatus)4 or with Masson-Fontana stain to exclude the presence of melanin. A wide variety of tumors can arise in the nail apparatus.24 In a recent study in Mexico, the most common neoplasms were fibrous tumors (29.05%), followed by osteocartilaginous tumors (21.79%), myxoid pseudocysts (11.96%), and malignant melanoma (9.82%).25

    View all citing articles on Scopus
    View full text