Dermoscopy of Subungual Exostosis: A Retrospective Study of 10 Patients

Abstract

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.

Subungual exostosis: Pediatric aspects

“…In the pediatric series of Letts et al [3], one-third of the locations spared the irst toe. The 2 children aged 6 in the Picollo et al series had a irst ray unharmed [4]. Finally, three of our ive cases were on the 2nd or 3rd toe.…”

“…Very few series have reported pediatric cases during the irst decade [3]. In the work of Piccolo et al, 2 patients were under 10 years of age [4]. Other authors have reported sporadic cases [5,6].…”

“…Histology con irms the diagnosis by highlighting an osteocartilaginous lesion similar to osteochondroma but different from the latter by the presence of a ibro cartilaginous cap rather than hyaline cartilage [4,10]. Recently, Piccolo et al reported the value of performing a dermoscopic diagnosis [4]. We believe that this examination is of little interest to young children.…”

Subungual Exostosis in a Young Soccer Player

“…Radiographically, the lesion is approximately 1 cm in diameter and projects from the dorsal or dorsomedial aspect of the distal portion of a terminal phalanx. It is composed of mature trabecular bone with attachment to the phalanx; the free end is flat, cupped and smooth, or irregular [ 9 ]. There is a large radiolucent cartilaginous cap [ 3 ].…”

“…There is a large radiolucent cartilaginous cap [ 3 ]. There is no cortical disruption or other abnormality of the distal phalanx [ 9 ]. Dermoscopy could be another useful technique, involved in the diagnostic process, although X-ray examination and histopathology are mandatory for the diagnosis [10].…”