Enlarging nodule under the toenail • no history of trauma • unremarkable medical history • Dx?

Our patient’s outcome

After orthopedic consultation, the lesion and a 5 × 5-mm portion of the adherent germinal nail matrix were resected operatively through a medial excision. A small flap of the lateral nail matrix was rotated to cover the matrix defect, and the wound was closed. Postoperatively, the patient experienced slow wound healing (a total of 3 weeks), but there was no recurrence of the lesion at the 2-month follow-up.

THE TAKEAWAY

Osteocartilaginous tumors present as rapidly growing lesions on the distal tips of fingers and toes, but they may also occur on long bones and on the skull. Rarely malignant in nature, most of these lesions can be differentiated by location, histopathologic features, and patient age at onset. Consider surgical consultation and excision for relief of pain and/or cosmetic reasons. Recurrence is rare.

CORRESPONDENCE
Michael Barna, MD, Naval Hospital Camp Lejeune, Department of Family Medicine, 100 Brewster Blvd, Camp Lejeune, NC 28547; Michael.m.barna.mil@mail.mil.