Onychomatricoma with Onychomycosis: A Case Report and Review of the Literature

Abstract

Onychomatricoma is a primary benign neoplasm of the nail matrix. Currently, a limited number of cases have been reported, so it is still considered a rare neoplasia. However, it is debatable if this condition is underdiagnosed and underreported. Onychomycosis is an important differential diagnosis of onychomatricoma, and sometimes, both these conditions may even coexist in the same nail. As the tumor grows, tissue microenvironment is more vulnerable to dermatophytes. Probably, the altered keratin appears to be susceptible to fungal invasion. Careful clinical assessment and dermoscopic evaluation help nailing the diagnosis. Usually, total nail avulsion is the preferred therapeutic approach when they coexist. Herein, we present a case of a middle-aged woman with onychomycosis and onychomatricoma affecting a single fingernail. The proposed therapy was oral terbinafine for 6 months followed by a conservative surgery. There were dramatic changes in dermoscopic features after fungal treatment, which, to our knowledge, have not been previously reported.

Blue onychomatricoma: Blue discoloration of an onychomatricoma secondary to pigmented onychomycosis

“…As shown in Table 1, a literature review demonstrates that there are nine cases of concomitant onychomycosis. [10][11][12][13][14][15] Not only can onychomatricoma be clinically misdiagnosed as onychomycosis, but concomitant fungi can also pose a histopathologic challenge. [16][17][18][19][20][21][22] This presents a diagnostic challenge as a nail clipping of an onychomatricoma may show onychomycosis, and a dermatopathologist unfamiliar with the other histopathologic features of a nail clipping from an onychomatricoma may miss the other diagnostic features.…”

“…As shown in Table 1, all cases show chromonychia with yellow and brown discoloration. [10][11][12][13][14][15] Onychoscopic features of onychomycosis have been described in 38.3%-61.9% of cases to demonstrate chromonychia, including green, yellow, and brown. [23][24][25] Chromonychia associated with onychomatricoma aside from xanthonychia is a rare phenomenon, and only a few cases of brownish discoloration mimicking nail unit melanoma or pigmented Bowen disease within an onychomatricoma were reported.…”

“…[7][8][9] Because the cavities of the onychomatricoma can serve as a sanctuary site for fungi, it is not unusual to find concomitant onychomycosis within an onychomatricoma. [9][10][11][12][13] As yet, a concomitant fungal infection has not been reported to cause associated chromonychia of an onychomatricoma. Herein, we report a case of an onychomatricoma that had a delayed diagnosis and a unique blue pigmentation, which was ultimately determined to be secondary to concomitant pigmented onychomycosis, and the clinicopathologic features of this phenomenon.…”

Onicomatricoma: puntos clínicos claves de una enfermedad infrecuente

“…El cuadro puede ser levemente doloroso o asintomático como el de nuestro paciente. Clínicamente se describe una tétrada clásica que incluye engrosamiento de la lámina ungular, xantoniquia, aumento de la curvatura transversa y hemorragias en astilla (6) . Dicha tétrada está presente en el 50% de los casos de onicomatricoma, la otra mitad de los casos podría cursar con una clínica muy variable, se ha descrito melanoniquia longitudinal, distrofía ungular, eritroniquia, leuconiquia, pterigion dorsal e incluso hematoma subungular al momento de presentación (2) .…”

“…Tabla 1. Diagnósticos diferenciales del onicomatricoma y sus características dermatoscópicas (6,(12)(13)(14)(15) . La resección quirúrgica es el tratamiento de elección, esta debe ser amplia y completa para así evitar recurrencias.…”