Common Nail Tumors
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
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Cited by (46)
Nail Tumors
2021, Dermatologic ClinicsCitation 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 DermatologyNail histopathology
2013, Actas Dermo-SifiliograficasCitation 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
Diseases seen during a hospital consultation of nail diseases: Prospective study
2013, Presse MedicaleA retrospective study on the clinical features of skin lesions in Chinese acquired digital fibrokeratoma patients
2024, Journal of Cosmetic Dermatology