Subungual Exostosis: Case Report and Review of the Literature

Abstract

Subungual exostosis is typically a benign, acquired tumor of cartilaginous bone occurring on the medial surface of the distal hallux. A 16-year-old boy with subungual exostosis of his left great toe is presented. We evaluated the English language literature on this topic from 1857 to 1994; including our patient, 312 cases have been described. The diagnostic characteristics (histologic and radiologic), etiologic features, and therapeutic management were reviewed. Subungual exostosis more commonly affects women than men in a ratio of 21. Most lesions occur in the early twenties; however, a minimum of 51 (16%) of the 312 cases of subungual exostoses appeared in children 18 years of age or younger. Seventy percent of lesions occurred on the first hallux. There was frequently an association with trauma. The diagnosis of subungual exostosis may be suspected from the clinical presentation and confirmed with radiographic examination. The treatment is surgical.

A giant subungual exostosis perforating through skin of the toe

“…The average age was 28.4 (4-80 years), the man/woman ratio being 2:1. It is of interest to note that there was previous local trauma in 64 cases [2]. There was not history of trauma in the case presented here.…”

“…The differential diagnoses include subungual verruca, pyogenic granuloma, glomus tumor, malignant disease of nail plate, keratoacanthoma, subungual epidermoid inclusion cyst, enchondroma, subungual melanoma, onychoptosis, nevus, clavus and Koebner phenomenon. Both the radiological and clinical findings are considered in making a diagnosis [2,6].…”

Les exostoses sous-unguéales du gros orteil

“…Une revue exhaustive de la littérature ne permet, cependant, de retenir sur plus de 300 cas d'ESU répertoriés que quatre associations avec le HME [13]. À ce jour, l'explication pathogénique privilégiée est celle de l'excroissance ostéocartilagineuse réactionnelle, secondaire à une sollicitation mécanique.…”

Benign Subungual Tumors

“…There are no mitoses in mature exostoses. 14 Treatment is surgical removal, with recurrence rates between 6% and 12%. To avoid recurrences, complete resection is recommended; however, the tumor may adhere to the nailbed, and resection in this region can lead to postoperative nail dystrophy.…”