HighlightsThis article represents a unique case of accessory/double nail of middle finger of hand.The key purpose is to highlight this case as there is no such data in existing literature.This surgical pathology can cause pain, discomfort and cosmetic concern.Being a rare entity, this condition can cause diagnostic confusion.Treatment is surgical excision.

Introduction: A rudimentary accessory or double nail of the middle finger of hand is extremely rare, although rudimentary accessory or double nail of the toes only described four times before in literature. Most cases are incidentally detected and only few patients seek help because they have discomfort and pain or cosmetic reasons. Some have a positive family history, but most patients cannot give any information concerning heredity or any previous trauma. Presentation: 28 years male presented with abnormal growth of the nail of middle finger of left hand which was hard. It was causing pain and discomfort to patient when touched. This growth was made of keratinized material and inseparable from nail bed which showed a longitudinal depression corresponding to a slight protuberance of the cuticle of primary nail. Discussion: being an extremely rare entity, this situation can lead to difficulty in diagnosis, so its symptoms and pattern of occurrence should be thoroughly noted. surgical excision is the only treatment of choice for patient's symptoms relief and cosmetic concern. Nail unit resection procedure can easily be performed under local anesthesia. Conclusion: Accessory nail of finger should be removed surgically due to pain and discomfort or cosmetic reasons and histopathology should be done afterwards. Highlights: