Subungual Exostosis in a Young Soccer Player

Abstract

BACKGROUND:Subungual exostosis is a relatively uncommon, benign osteocartilaginous tumor of the distal phalanx of the toes or fingers in young adults, considered as a rare variant of osteochondroma. Differential diagnoses include subungual verruca (viral wart), pyogenic granuloma, osteochondroma, amelanotic subungual melanoma and glomus tumour. Misdiagnosis and total onychodystrophy frequently occur as a result of late treatment or inadequate treatment strategy. Dermoscopy could be a useful technique, involved in the diagnostic process, although X-ray examination and histopathology are mandatory for the diagnosis.CASE REPORT:We report a rare case of subungual exostosis of the great toe associated with repeated trauma of the nail bed. The lack of radiographic and histopathological examination could lead to misdiagnosis and inadequate treatment. Although completely benign, subungual exostosis should be considered in differential diagnosis of nail bed tumors in young adults, in order to avoid associated complications and unneeded aggressive surgical interventions.CONCLUSION:Complete excision of the lesion and delicate separation from the underlying nail bed structures results in total resolve of the problem, by providing the lowest risk of recurrences.

Subungual osteochondroma: case report and review of clinical, radiologic and ultrasound presentation versus subungual exostosis

“…3 Clinically, they present as firm solitary nodules, with or without associated nail plate deformity, and run asymptomatic or with pain and oppression in the affected finger or toe. 9,11 Clinical differential diagnosis of either subungual osteochondromas or exostosis includes ingrown toenails, verruca vulgaris, pyogenic granulomas, glomus tumors, fibromas, keratoacanthomas, squamous cell carcinomas, subungual malignant melanomas as well as bacterial or mycotic infections. 8,12 Subungual osteochondroma's US findings have been briefly described as well-defined rounded hypoechoic images with increased vascularization 13,14 our case showed an hypoechoic band in keeping with the cartilaginous cap, bounded by an echogenic bony protuberance on its deep surface, enlarging the nail bed and displacing upwards the nail plates; however, Color Doppler US did not reveal vascularity.…”

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

“…22 Complete excision of the lesion and careful separation from underlying nail bed structures yield the lowest rates of recurrence and future complications. 23 In SE surgery, surgical excision of the mass without damaging the nail bed is important. The nail bed should be repaired after removal of the mass if it has been damaged during surgery.…”

“…Postoperative recurrence of SE has been reported, followed by spontaneous regression 22 . Complete excision of the lesion and careful separation from underlying nail bed structures yield the lowest rates of recurrence and future complications 23 . In SE surgery, surgical excision of the mass without damaging the nail bed is important.…”

Ultrasound in Sports and Occupational Dermatology

“…This is more frequent in soccer, football, hiking, running, and climbing. 49,61,62 An ultrasound examination is commonly performed before radiography because the exostoses are potent clinical simulators of other nail conditions, including nail tumors. On ultrasound imaging, there is a hyperechoic and eccentric band with posterior acoustic shadowing that connects with the bony margin of the distal phalanx.…”

“…The appearance of subungual exostosis has been related to trauma, commonly in the feet. This is more frequent in soccer, football, hiking, running, and climbing 49,61,62 . An ultrasound examination is commonly performed before radiography because the exostoses are potent clinical simulators of other nail conditions, including nail tumors.…”