​​Longitudinal Erythronychia Secondary to a Wooden Splinter.

Longitudinal erythronychia (LE) is a term for red streaks in the nail which can be caused by a range of diseases. The specific type of longitudinal erythronychia can correlate with certain associated conditions making it important to properly categorize when discovered. A 71-year-old Hispanic male presented to the clinic with a type 1A LE associated with subungual keratosis that had been asymptomatic for approximately 12 months. The patient denied injury, pain, cold sensitivity, or cosmetic distress. The working diagnosis was squamous cell carcinoma in situ (SCCIS) vs. onychopapilloma or glomus tumor. A 4mm punch biopsy from the distal nail matrix was performed, and dermatopathology revealed that the LE was secondary to a wooden splinter. After a literature review, it was discovered that this is the first confirmed case of LE secondary to a splinter. Future providers should keep splinters as a potential differential diagnosis, especially as they evaluate LE, but ultimately all suspicious type IA lesions should be biopsied to rule out potential insidious pathologies, such as SCCIS and malignant melanoma.

Tumoración subungueal, no siempre son partes blandas / Subungual tumor, not always soft tissue

La exostosis subungueal es un tipo de tumor óseo benigno, muy infrecuente en la infancia, que se localiza habitualmente en la falange distal del primer dedo del pie. Se presenta como una tumoración dolorosa que afecta a la uña y a los tejidos blandos periungueales. En su diagnóstico diferencial se incluyen lesiones dermatológicas como la verruga vulgar o el granuloma piogénico, y tumores óseos como el osteocondroma. El diagnóstico definitivo se basa en los hallazgos radiológicos e histopatológicos. Su tratamiento es la exéresis quirúrgica y suele tener buen pronóstico (AU)

Subungual exostosis is a benign bone tumor, very unusual in childhood, which is usually located in the distal phalanx of the first toe. It presents as a painful tumoration that affects the overlying nail and the periungual soft tissues. The differential diagnosis includes dermatological lesions such as common warts or pyogenic granuloma, and bone tumors such as osteochondroma. The final diagnosis is based on the radiological and histopathological findings. The treatment is surgical excision and the outcome is usually favourable. (AU)

Subungal squamous cell carcinoma of the thumb - Implications for patient setup and radiotherapy planning.

Subungal squamous cell carcinoma (SSCC) is a rare malignancy of the nail bed. We present the case of a woman diagnosed with a SSCC of the right thumb. Initial management consisted of surgically excision followed by adjuvant radiotherapy due to a positive bone margin. We describe the patient set-up, immobilisation technique, target volume delineation, radiotherapy planning, fractionation schedule, image guidance and patient outcomes.

Assessment, management and treatment of acute fingertip injuries.

Fingertip injuries with nail bed trauma can require specialist hand surgery, depending on severity. However, most of these injuries can be managed in well-equipped emergency departments by emergency nurses with an in-depth knowledge and understanding of the anatomy and physiology of the fingernail and surrounding structures, assessment and examination, pain management and treatment. This article describes the surface and underlying anatomy and physiology of the nail, the most common mechanisms of injury, relevant diagnostic investigations, and initial assessment and management. It also discusses treatment options, referral pathways, and patient discharge advice.

Nail bed defect covered with labial mucosa graft after subungal glomus tumor removal.

The nail bed is an important part of the nail unit. It supports the nail plate, but does not regenerate itself. The labial mucosa and the nail bed both lack a granular layer. Because the keratinization of the nail bed can cause poor nail adhesion, harvesting graft from nonkeratinized sites is preferred. Furthermore, harvesting graft from labial mucosa is convenient in surgical approach. Therefore, the labial mucosa is more eligible for covering the nail bed defect than other graft methods. In this report, a 46-year-old female patient suffered from a subungal glomus tumor of the right fourth fingernail bed for 10 years. After the nail plate was removed, complete excision of the tumor was performed, and a labial mucosa graft was used to cover the defect. Eight months after the operation, the tumor had not reoccurred and no nail deformity was observed. This outcome demonstrates that our procedure is a good surgical option for treatment of nail bed defects.

Thin Split-Thickness Toe Nail-Bed Grafts for Nail Bed Defects in Subungal Exostosis: Two Cases Report / 대한골관절종양학회지

We reviewed the clinical features of 2 patients who underwent surgery for subungal exostosis, focusing on postoperative deformity of the nail. The lesion destroyed the nail bed and was excised with a direct approach. then thin split-thickness sterile matrix graft was done after excision of the tumor because the defect of the nail bed was large. Good postoperative appearance of the nail was obtained by thin split-thickness sterile matrix graft. The use of thin split-thickness sterile matrix graft for the replacement of a nail bed defect can regain a smooth, adherent, and normal-looking nail and avoid donor-site morbidity. Thin split-thickness toe-nail bed graft is a good choice for the prevention of postoperative deformity.

Cytodiagnosis of glomus tumor.

Glomus tumors are uncommon, with an estimated incidence of 1.6%. Cytological descriptions of this tumor are few. We report a 15-year-old boy presenting with a painful subungual swelling. Fine needle aspiration cytology showed uniform cells with homogeneous chromatin and scanty cytoplasm. Cytology was reported as "suggestive of glomus tumor". Histopathological examination confirmed the diagnosis. Careful cytomorphological examination supported by appropriate clinical history should suggest the diagnosis of glomus tumor and help in preoperative diagnosis.

Subungual Glomus Tumor Resection with Partial Detachment of Nail Plate

PURPOSE: A glomus tumor is a rare tumor with predilection for the hand. The curative treatment is complete surgical excision. Transungual approach is one of usual options for subungual glomus tumor, but the major complication of this method is nail deformity. The authors describe the different operation to avoid this complication. MATERIALS AND METHODS: From April, 2005 to May, 2009. 9 patients were diagnosed with digital glomus tumors. 8 patients were underwent excision with transungual open window exposing nail bed using partial detachment of nail plate. In all patients, preoperative clinical diagnosis was confirmed postoperatively with the biopsy result. RESULTS: All cases were followed up for average 4.2month(range 6 weeks to 13 months). Symptoms were improved after surgery. No complication and recurrence were occurred. There were no nail deformities by this altered approach. CONCLUSIONS: This altered technique with partial detached nail plate represent a safe and effective result to excise digital glomus tumors in subungual lesion.

A Case of Subungal Abscess and Onycholysis Induced by Docetaxel / 결핵및호흡기질환

Docetaxel is a taxoid antineoplastic drug, which is widely used to treat locally advanced or metastatic non-small cell lung cancer (NSCLC). Among the adverse dermatological reactions, nail disorders such as bending, onycholysis, hypo- or hyperpigmentation are rare. We report a case of a 62-year-old male with advanced NSCLC (cT4N3M1, stage IV), who developed purulent discharge and onycholysis in the nail of all his fingers and the left great toe after five courses of anti-neoplastic chemotherapy, which included docetaxel (cumulative dose: 370 mg/m2, 590 mg). Seven days after the final session of chemotherapy, the patient had become aware of discoloration and swelling of the nail beds with out pain. Three days later, greenish-yellow purulent discharge oozed out from the involved nails. Microbiologic studies revealed Pseudomonas aeruginosa. Intravenous and topical antibiotics (mupirocin) were applied. After 2 weeks, regrown nails were observed and the onycholysis had improved.

Multiple Subungual Osteochondromas: A Case Report / 대한정형외과학회잡지

The osteochondroma is a common benign bone tumor, which is only rarely observed in a subungal location, especially in the fingers. We present a case of multiple subungal osteochondromas, which occurred in the distal phalanges causing nail deformities and pain.

A Case of Subungal Abscess And Onycholysis Related to Docetaxel / 대한피부과학회지

Docetaxel is a new taxoid antineoplastic drug widely used for advanced breast cancer, lung cancer, and head and neck cancer. Skin and nail change is one of the most frequent nonhematologic adverse reactions. Nail changes include dark pigmentation, subungal hemorrhage, acute paronychia, onycholysis and Beau's line. A 43-year-old woman with metastatic stomach cancer developed painful subungal abscess and secondary onycholysis of all fingernails after three courses of docetaxel chemotherapy(cumulative dose: 360mg). Puncturing under the nail plate expressed a purulent serous fluid. Microbiological cultures revealed heavy growth of Staphylococcus aureus. The docetaxel therapy was discontinused and 3rd generation cephalosporin was started. After 3-weeks antibiotic therapy, subungal abscess was improved. To our knowlege, this is the second case report of subungal abscess related to docetaxel chemotherapy.

Reconstructive Treatment of Subungal Malignant Melanoma Through the Early in Situ Level Diagnosis

Subungal malignant melanoma is a relatively rare disease with reported incidence between 1% to 3% of all melanoma cases in the USA, 10% to 31% in Japan. It is a serious disease with a survival period of 5 years. This poor prognosis is the result of late diagnosis in many of the cases, usually the patient not presenting himself early enough in the course of the disease. However, far more important is the frequent failure of the physician or surgeon to recognize the clinical signs and to perform a biopsy from the correct site, which leads to an accurate diagnosis. Therefore we focused the nail color change of the subungal malignant melanoma to diagnose the disease at the early stage. Five patients who visited our hospital with nail color change into black took the biopsy. This should be done on nail bed and matrix lesions which shows color change into black. A wedge form is taken from the area with maximal clinical concern, including normal tissue at the edge of the lesion. In cases of melanoma in situ (4 cases) diagnosed during the previous biopsy, surgical treatment was done as soon as possible. The melanoma was excised by Mohs technique and the margins were checked by frozen section. If the margins and base of tumor did not have micrometastasis, immediate reconstruction using various flaps was done. In case that micrometastasis was suspicious however, special staining using HMB45 immunostaining was done for confirmation. After a few days for special staining, delayed reconstruction was done. By means of the early diagnosis and Mohs micrographic operation technique, we could excise the tumor completely and preserve the tendon, bone, joint and length of digits.

Subungal Exostosis / 대한정형외과학회잡지

Four cases of subungal exostosis are presented. All of them were young male and big toe was involved in 2 cases. Histological features of subungal exostosis was characteristic; the cancellous bony stalk was capped mainly fibrocartilage, although scattered areas of hyaline cartilage were also found where enchondal ossification occured. Superficial to this cartilaginous cap, there was fibrous tisse covering. When terminal phalax of a toe shows deformity of nail and skin changes due to hard mass, radiological examination is required for the proper diagnosis and treatment. Complete local excision is required but damage to the nail bed during excision should be avoided.