Subungual Exostosis: A Case Series of 48 Patients

Background

Subungual exostosis is an unusual benign nail tumor, mostly located on the big toe. It generally affects young people and manifests as uncomfort during footwear.

Method

A monocentric retrospective study was conducted at the outpatient consultation for nail disorders at the Department of Dermatology of the University of Casablanca, Casablanca, Morocco, between April 2006 and October 2019.

Results

We diagnosed subungual exostosis in 48 patients, including 25 men and 23 women, with an average age of 20 years. The subungual exostosis was located on the hallux in 34 cases, the second toe in 10 cases, and the index finger in 2 cases. Nail trauma was found in 27 patients. The tumor was entirely excised in all the patients.

Conclusion

Large series of subungual exostosis are reported by orthopedic surgeons. However, our outpatient consultation for nail disorders allowed the diagnosis and appropriate management of subungual exostosis.

A Subungual Exostosis Mimicking a Periungual Granuloma in a 9-Year-Old Boy: An Unexpected Dermoscopic Pattern

Subungual exostosis (SE) is an uncommon osteocartilaginous tumor. Classic dermoscopic features of SE include vascular ectasia, hyperkeratosis, onycholysis, and ulceration. In this case, a 9-year-old boy presented SE showing a dermoscopic mesh dilated blood vessel pattern surrounded by a scar-like peripheral ring, which represents a novel finding in the medical literature.

Subungual exostosis of the finger in an 8-year-old girl

INTRODUCTION

Subungual exostosis (SE) is a relatively uncommon benign bone tumor that occurs in the distal phalanges of the toes or fingers.

CASE PRESENTATION

An 8-year-old girl presented for treatment of an acquired mass on the distal right index finger. The patient was preoperatively diagnosed with a benign bone tumor. Surgical resection of the distal right index finger mass was performed under general anesthesia, and histological examination of the resected tissue supported a diagnosis of SE of the right index finger. The surgical outcome was good, with no surgical site infection. Throughout 15 months of follow-up, the patient was asymptomatic with no recurrence.

CONCLUSION

Surgical resection of a mass on the distal right index finger resulted in absence of recurrence during 15 months of follow-up. SE is a benign and uncommon lesion that is infrequently encountered by physicians. This infrequent occurrence may result in delays in diagnosis and treatment. Complete excision of the lesion and careful separation from underlying nail bed structures results in total resolution of the lesion, while providing the lowest risk of recurrence.

Dermoscopy of Subungual Exostosis: A Retrospective Study of 10 Patients

INTRODUCTION

Subungual exostosis (SE), the most common nail tumor of young adults, is a benign bony proliferation of the distal phalanx occurring beneath the nail. Misdiagnosis or late diagnosis frequently occurs and no dermoscopy features of this tumor were previously outlined.

MATERIAL AND METHODS

To describe the dermoscopic appearance of SE, 10 patients with radiologically and histologically confirmed SE were retrospectively retrieved from our tertiary referral centers. Data regarding age, gender, time to diagnosis, clinical presentation, dermoscopic features, involved nail and history of trauma were recorded for each patient.

RESULTS

In our patients, clinical findings were similar to previous reports. Among the dermoscopic features, vascular ectasia was the most common finding (70%), followed by hyperkeratosis (60%), onycholysis (40%), and ulceration (30%).

CONCLUSION

Dermoscopy could be a useful technique aimed at creating diagnostic suspicion of this benign nail condition, although X-ray examination and histopathology are mandatory for the diagnosis.

Dystrophy of the Great Toenail by Subungual Exostosis and Hyperostosis: Three Case Reports with Different Clinical Presentations

Subungual exostoses and hyperostoses of the great toenail are a differential diagnosis of nail tumors. We present 3 cases of subungual exostosis/hyperostosis with secondary nail dystrophy: a 36- and a 37-year-old woman as well as an 8-year-old boy. Two of the 3 patients suffered from pain. The 2 female patients presented with the classic dorsolateral firm protrusion, while the child presented with bilateral nail dystrophy with lateral wall hypertrophy. In this later case, a bony ridge was identified, which is an unusual subungual, nonprotruding type of exostosis. The hypertrophic lateral walls were removed by the Vandenbos technique. In the 2 former cases, complete excision of the bony lesions was performed with a proximal block. Healing by second intention was uneventful.

Preoperative Assessment Using Magnetic Resonance Imaging for Subungual Exostosis beneath the Proximal Region of the Nail Plate

Subungual exostosis is a benign calcifying projection that occurs on the distal phalanx beneath or beside the nail. The problems in treatment are frequent postoperative recurrence and nail deformity or loss. Here, we describe the case of a male patient with a subungual exostosis beneath the proximal region of the nail plate of the right big toe. A precise preoperative evaluation of the anatomical structure using magnetic resonance imaging was useful for removing the subungual exostosis.