Sonographic Features of Onychopapilloma: A Single Center Retrospective Observational Study

Abstract

(1) Background: Onychopapilloma is a benign tumor of the nail bed and distal matrix. which usually manifests as monodactylous longitudinal eryhtronychia associated with subungual hyperkeratosis. The impossibility to rule out a malignant neoplasm is an indication for surgical excision and histological examination. Our aim is to report and describe the ultrasonographic features of onychopapilloma. (2) Methods: we conducted a retrospective analysis of patients with a histological diagnosis of onychopapilloma who underwent ultrasonographic examination in our Dermatology Unit from January 2019 to December 2021. (3) Results: Six patients were enrolled. Erythronychia, melanonychia, and splinter hemorrhages were the main dermoscopical findings. Ultrasonography detected nail bed dishomogeneity in three patients (50%) and a distal hyperechoic mass (5 patients, 83.3%). Color Doppler imaging did not show vascular flow in any of the cases. (4) Conclusions: the detection of a subungual distal non-vascularized hyperechoic mass by US, together with classical onychopapilloma clinical features, supports the diagnosis, especially in those patients who were unable to perform excisional biopsy.

Ultrasound Features of Onychopapilloma at High‐Frequency and Ultra‐High Frequency

“…Although we failed to detect nail bed dishomogeneity and a clear‐cut distal hyperechoic mass reported by Mattioli et al, 3 we speculate that their finding may correspond to the hyperkeratotic changes and irregularities of the distal nail plate, which could be enhanced by US artifacts resulting from using a lower frequency setting and a small amount of gel overlying the nail plate in comparison with our cases.…”

“…Our findings largely support those published by Mattioli et al, 3 but we also identified two additional anatomical features that could aid in characterizing onychopapilloma from an ultrasound perspective and assist in pre-surgical mapping.…”

“…2 Recently, a case series by Mattioli et al reported the ultrasound features of onychopapilloma in six patients. 3 Using a multifrequency linear array transducer operating at 15.0-18.0 MHz, the authors observed nail bed inhomogeneity in 50% of patients and a distal hyperechoic mass in 83% of patients. These findings correlated with nail bed acanthosis, papillomatosis, layered hyperkeratosis, and subungual keratogenous zone.…”

“…Onychopapilloma is a benign nail tumor originating from the distal nail matrix and extending along the nail bed 2 . Recently, a case series by Mattioli et al reported the ultrasound features of onychopapilloma in six patients 3 . Using a multifrequency linear array transducer operating at 15.0–18.0 MHz, the authors observed nail bed inhomogeneity in 50% of patients and a distal hyperechoic mass in 83% of patients.…”

Expanding the Differential Diagnosis of the Painful Nail: A Case of an Onychopapilloma with Neuroma

“…In a retrospective single-center study of 65 patients who underwent nail biopsy for LE, onychopapilloma was the most common cause, diagnosed in 67% of monodactylous LE cases (41/61) [ 5 ]. However, other benign conditions and tumors, including glomus tumor, verruca vulgaris, lichen planus, warty dyskeratoma, and malignant neoplasms, such as Bowen’s disease, squamous cell carcinoma, and amelanotic melanoma, must be considered in the differential diagnosis of localized LE [ 6 , 7 ]. Surgical excision with histological confirmation is often required for diagnosis as clinical and dermoscopic features cannot rule out malignancy [ 6 ].…”