Ram′ s horn nail - Giant onychomatricoma treated by complete surgical excision- A rare case report

Onychomatricoma is a rare benign fibroepithelial filamentous tumor originating from the nail matrix. It typically presents with the clinical tetrad of xanthonychia, pachyonychia, proximal splinter hemorrhages and increased transverse overcurvature of the nail plate. The giant variant can easily confuse the clinician due to its extensive nail dystrophy that can mask the characteristic features of this tumor. Benign (fibrokeratoma, ungual fibroma, onycholytic matricoma) and malignant entities (Bowen's disease, squamous cell carcinoma, onycholytic carcinoma) are mimics of the disease. Nail surgery can facilitate the diagnosis, which should always be confirmed by histology, as rare variants do exist.

Section: Discussionsupporting

confidence: 55%

Giant Onychomatricoma of the Great Toenail: Case Report and Review Focusing on Less Common Variants

Prevezas

Triantafyllopoulou

Belyayeva

et al. 2015

“…Most of the reports on onychomatricoma present tumors found only in a portion of the nail plate, demonstrated by a superficial band-like pattern of yellowish discoloration with increased transverse curvature of the nail. To date there have been 5 reported cases of giant onychomatricoma (Table 1), all of them with a history of prior trauma [10,11,12,13]. Interestingly, all tumors were found to be located on the great toenail or thumbnail, which are areas that are potentially more susceptible to trauma.…”

Section: Discussionmentioning

confidence: 99%

Onychomatricoma: A Rare Nail Tumor with an Unusual Clinical Presentation

Kamath

Villada

et al. 2017

First described in 1992, onychomatricoma is a rare, benign, fibroepithelial tumor of the nail matrix with few reported cases in the literature. The tumor predominately affects the fingers of Caucasian women during the 5th decade of life and is typically slow growing and painless. The authors present a unique clinical presentation of a giant onychomatricoma in a darker-skinned 60-year-old South Asian individual who presented with a large dome-shaped nail that was smooth, shiny, and green.

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

Jaeger

Canella

Leverone³

et al. 2021

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.