Four Fattened Phalanges
Match the diagnosis to the photo by letter
a. Digital fibromyxoma
b. Dermatofibrosarcoma protuberans
c. Subungual exostosis
d. Onychomatricoma
For answers, see next issue; for discussion, go to www.mdedge.com/clinicianreviews/picture
Case presentations and photographs courtesy of Cutis. Copyright 2018 Frontline Medical Communications Inc.
Answers to November “Picture This” (Clinician Reviews. 2017;27[11]:39): 1c, 2a, 3b
2. A 21-year-old woman has a slow-growing, asymptomatic nodule on the great toe. She denies antecedent trauma. A firm, flesh-colored, semimobile, nontender, subungual nodule can be seen in the distal lateral nail bed, extending into the adjacent tissue. Radiographic exam shows focal calcification of the nodule, with direct communication to the underlying distal phalanx.
Diagnosis: Subungual exostosis is a relatively uncommon, benign, osteocartilaginous tumor arising from the distal phalanx beneath the nail. It typically appears on the great toe during the second to third decade of life and has an equal incidence in both sexes. Its similarities to other dermatologic disorders involving the nail bed can lead to misdiagnosis, which may result in inadequate or extreme treatment.
,For more information, see “Subungual Exostosis.” Cutis. 2012;90(5):241-243.
