Onychopapilloma: its clinical, dermoscopic and pathologic features

Abstract

Background Onychopapilloma is a benign tumour of the nail bed and distal matrix and commonly presents as longitudinal erythronychia, longitudinal leukonychia or longitudinal melanonychia. Because onychopapilloma is rare, its clinical characteristics and dermoscopic findings have not been well investigated in Asia. Objectives This study aimed to investigate the clinical characteristics and dermoscopic and pathologic findings of onychopapilloma in Korea. Methods We retrospectively reviewed the medical records and clinical/dermoscopic photographs of 39 patients diagnosed with onychopapilloma in the Pusan National University Hospitals (Busan and Yangsan) for 11 years (2010–2021). Results Among 39 patients, 23 (59.0%) were men, and 16 (41.0%) were women. The mean age was 46.1 (16–77) years. All lesions were single, and most of them were located on the fingers (92.3%), especially the thumb (66.7%). The most common clinical feature was longitudinal erythronychia (56.4%), and the most common dermoscopic finding was distal subungual hyperkeratosis (100%). We found two new dermoscopic features: macrolunula and trailing lunula along the longitudinal band. Among 18 patients who underwent surgical excision, only 6 (33.3%) showed typical acanthosis and papillomatosis on the nail bed. Conclusions We found that Asian onychopapilloma has similar clinicodermoscopic findings to the Caucasian one, that is to say, longitudinal erythronychia and distal subungual hyperkeratosis were the most common nail change and dermoscopic finding, respectively. We propose two new dermoscopic features of onychopapilloma: macrolunula and trailing lunula along the longitudinal band.

Expanding the Differential Diagnosis of the Painful Nail: A Case of an Onychopapilloma with Neuroma

“…For our patient, glomus tumor or leiomyoma and less likely onychopapilloma was considered in the differential diagnosis due to the associated pain. In a retrospective study analyzing the clinical and pathologic features of 39 onychopapilloma cases, 23.1% of patients reported tenderness (but not pain), while 38.5% reported functional discomfort without tenderness and 59% were asymptomatic [ 11 ]. In another retrospective study of 68 onychopapilloma cases, 40.7% of patients reported associated pain (quality of pain unspecified) and 14.8% of patients were asymptomatic.…”

Basic Concepts in Nail Pathology

“…This may be clinically evident as longitudinal erythronychia, melanonychia, or leukonychia; as subungual keratosis; as yellowish brown chromonychia; as distal fissures of the plate; or as splinter hemorrhages. [35][36][37][38][39] It should be remembered that onychopapillomas are usually asymptomatic, that is, the presence of pain in a subungual tumor should lead one to suspect that it is not an onychopapilloma. Onychopapilloma is a much more frequent pathology in the fingers than in the toes, the thumb of the left hand being the most frequently affected finger.…”

Three atypical/malignant onychopapillomas in a 52‐case series with immunohistochemical study

“…OP presents as a longitudinal band with erythronychia 4,5 more rarely melanonychia, 2,3,6 or leukonychia 7,8 . Splinter hemorrhages, distal onycholysis, and/or fissuring of the nail plate due to distal subungual keratosis are frequently observed 9–13 . The histopathological alterations predominate in the nail bed, particularly in the distal nail bed.…”