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Published in Ashfaq A Marghoob, Ralph Braun, Natalia Jaimes, Atlas of Dermoscopy, 2023
Amélie Boespflug, Félix Pham, Ralph P. Braun, Luc Thomas
A yellow, well-demarcated, structureless, round to ovoid spot is observed in subungual exostosis. It is created by the pressure exerted by the bone pressing on the nail bed Figure 11d.16.
Surgery of some common nail tumors
Published in Robert Baran, Dimitris Rigopoulos, Chander Grover, Eckart Haneke, Nail Therapies, 2021
Subungual exostosis (Figure 21.6) is a relatively common lesion mostly seen under the big toenail in children and young adults. The nail is lifted up on one corner by a tumor that has a very smooth shiny surface, is stone-hard on palpation, and exhibits a very characteristic collarette-like margin, which represents the border between the pulp skin and nail bed. Ulceration may occur with time. Pain is exceptional. The diagnosis is confirmed by radiography, which also allows the entire extent of the exostosis to be seen; this is important as remnants of the base when left behind may cause recurrences. Subungual exostoses were believed to be reactive to chronic repeated trauma as they were frequently observed in ballet dancers, kick boxers, and other persons performing martial arts sports; however, as investigations demonstrated a tumor-specific chromosomal translocation t(X genes;6)(q14-14;q22) with a rearrangement of COL12A1 and COL4A5 a true neoplasm was suggested (Haneke 2017; Richert et al. 2019; Haneke 2011).
Onycholysis
Published in Nilton Di Chiacchio, Antonella Tosti, Therapies for Nail Disorders, 2020
Shari R. Lipner, Carlton Ralph Daniel
Simple onycholysis is a diagnosis of exclusion. A careful history, the absence of characteristic clinical findings, and observation of the patient in the examination room will rule in/out onychophagia and onychotillomania (Figure 15.2). Phototoxic or allergic dermatitis can often be confirmed or negated by taking a careful contactant and drug history. Nail clippings with histopathology and staining (PAS [periodic acid–Schiff], GMS [Grocott's methenamine silver], gram stains) are helpful in ruling out nail psoriasis, onychomycosis, and P. aeruginosa infections. Scrapings from under the nail plate can also be analyzed with microscopy and KOH, fungal culture, or polymerase chain reaction to confirm or negate presence of a nail fungal infection. Although Candida species may be cultured, they are almost always colonizers rather than pathogenic. A wound culture can be used to confirm the presence of P. aeruginosa when the nail plate appears green-brown (Figure 15.3). Subungual exostosis can easily be eliminated from the differential diagnosis by obtaining an x-ray. If there is any suspicion of a malignant nail tumor, a nail biopsy must be performed.
Benign growing mass of the digit presenting as an ulcerated mass – case report and review of the literature
Published in Case Reports in Plastic Surgery and Hand Surgery, 2021
J. Nunes Pombo, A. Nixon Martins, C. Paias Gouveia, B. Pena, D. López-Presa, G. Ribeiro
The majority of cases demonstrated negative staining to S – 100, CD 34, cytokeratin (MAK-6 and CAM 5.2), desmin, and epithelial membrane antigen (EMA) [3,11,18,25–27]. Diagnosis is challenging – FOPD is a rare disease with only 174 cases documented, and it shares many histological and clinical features with malignant disease. This might lead to incorrect diagnoses, such as extraskeletal osteosarcoma, resulting in unnecessary procedures, including amputation. It should, however, be considered as a potential diagnosis of fast-growing tumors of the hand or feet with no previous history of trauma [42]. Osteosarcoma is usually diagnosed in older people (scarcely under 40) and is rarely found in the fingers, being more common in the large bones of the upper and lower extremities [42]. Myositis ossificans has been associated with FODP, being the latter considered by some authors as a superficial variant of the first. However, in myositis ossificans there is commonly a history of trauma [38,42,51]. Other differential diagnosis include bizarre parosteal osteochondromatous proliferation (Nora’s lesion), ossifying plexiform tumor, acral osteoma cutis, and subungual exostosis [45,50].