Clinical and onychoscopic features of histopathologically proven onychopapillomas and literature update

Abstract

Background: Onychopapilloma is a benign tumor of the distal nail matrix and proximal nail bed with heterogeneous clinical presentations. It poses a diagnostic challenge because it could mimic subungual malignancies and inflammatory conditions. Clinical, onychoscopic, and histopathological clues play critical roles in diagnosis.Methods: We performed a retrospective chart review of onychopapilloma cases collected over 10 years, and characterized the clinical, onychoscopic, and histopathological features of onychopapilloma at an academic institution.Results: We obtained 17 biopsy-confirmed cases of onychopapilloma. Among our cases, we found manifestation of onychopapilloma as longitudinal erythronychia, longitudinal leukonychia, yellow-brown chromonychia, and longitudinal melanonychia.Long longitudinal or short splinter hemorrhages may be present. Distal fissuring with V-shaped notch, subungual keratotic mass, and onycholysis are other discernable features. Histopathological features include papillomatosis, epidermal hyperplasia, acanthosis of the distal nail bed, premature keratinization, matrix metaplasia, hyperkeratosis, and splinter hemorrhages; histopathological signs of malignancy were not observed in any of our cases.Conclusions: Onychopapilloma has polymorphic clinical and morphological features.Onychoscopic and histopathological studies are important to help exclude malignant mimickers. Consider onychopapilloma in the differential diagnoses of a monodactylous longitudinal streak in the nail, especially on the left thumb of an adult female.

Diagnosis and surgical treatment of benign nail unit tumors

“…In cases with pigmentation, a melanocytic lesion or onychocytic acanthoma should also be considered 31 . Sometimes dermatoscopy highlights erythema of the lunula with minute telangiectasias and splinter hemorrhages, better seen as single or multiple thin purple to black interrupted and irregular lines 32 …”

Thoughts on surgical excision of onychopapilloma

“…Onychopapilloma (OP) is a benign tumor of the nail bed and distal matrix, although malignancy has been reported recently. [1][2][3] It has many different clinical manifestations. Most cases present not only as longitudinal erythronychia, but also as leukonychia, melanonychia, yellow-brown chromonychia, splinter hemorrhages, distal nail plate fissuring, or onycholysis.…”

“…Most cases present not only as longitudinal erythronychia, but also as leukonychia, melanonychia, yellow-brown chromonychia, splinter hemorrhages, distal nail plate fissuring, or onycholysis. 1,[4][5][6] It is histopathologically characterized by the following features: matrix metaplasia of the nail bed epithelium, acanthosis of the distal nail bed epithelium, distal subungual hyperkeratosis, and multinucleated cells in some cases. [4][5][6] Although the severity of involved nails varies, there is a demand for treatment in some patients.…”

“…Onychopapilloma (OP) is a benign tumor of the nail bed and distal matrix, although malignancy has been reported recently 1–3 . It has many different clinical manifestations.…”

Diagnose und chirurgische Behandlung gutartiger Tumoren der Nägel

“…In Fällen mit Pigmentierung sollte auch eine melanozytäre Läsion oder ein onychozytisches Akanthom in Betracht gezogen werden 31. Manchmal hebt die Dermatoskopie ein Erythem der Lunula mit sehr kleinen Teleangiektasien und Splitterblutungen besonders hervor, die besser als einzelne oder mehrere dünne violette bis schwarze unterbrochene und unregelmäßige Linien zu erkennen sind 32. HistopathologieTypisch für das Onychopapillom sind epidermale papillomatöse Akanthose, Metaplasie der Matrix des Nagelbetts und Hyperkeratose am Hyponychium.…”