Transungual surgical excision of subungual glomus tumour

Abstract

Background:Glomus tumours are rare vascular tumours arising subungually in fingernails. Surgical excision provides histopathologic diagnosis and rapid resolution of symptoms.Objective:Present study was aimed at delineating common presentations and long-term treatment outcome of this rare subungual tumour. Patients and Methods: The clinical features and imaging results for 10 patients with subungual glomus tumours were recorded. All were treated with transungual excision. Per-operative findings and, treatment outcomes were recorded and analysed.Results:Females outnumbered males with average age being 33.3 ± 7.55 years. Presenting symptoms were severe pain (100%); nail-plate discoloration and onycholysis. X-ray was normal in 70%, though a magnetic resonance imaging done for five, helped visualise the lesion in three patients. The tumour involved nail bed in five cases and matrix in five, with an average size being 6.1 ± 2.13 mm (range 3-11 mm). An average follow-up of 16.8 months (range 8-24 months) was largely uneventful with longitudinal ridging in two cases and recurrence in two (both attributed to a sister lesion).Conclusion:Subungual glomus tumours have characteristic clinical presentation. Imaging is helpful pre-operatively but has a low success rate. Transungual surgical excision is safe and effective, allowing better visualisation, easy exploration and minimal long-term complications.

Our Experience with Glomus Tumor

“…Pain is the dominating symptom and one which is most discomforting to the patient. The tumor is sensitive to temperature changes, resulting in contraction of myofilaments and rise in intracapsular pressure, which is transmitted via the unmyelinated nerve fibers leading to the perception of pain [8]. Diagnosis is made largely on clinical basis.…”

“…The complications of surgery are nail deformity and recurrence. Recurrence has been recently attributed to the presence of satellite lesions [8], which are not recognized during surgery and regrow with time and cause pain. The nail deformity could be due to surgical insult of the nail bed or adhesions between matrix and proximal nail fold.…”

Glomus tumor - a case report

“…It was an indication for excision in local or general anesthesia. After consulting a plastic surgeon in a tertiary institution, the excision was done with transungual approach, which is most frequently performed [13]. According to Vasisht, surgical excision using lateral subperiosteal approach can be done as well [14].…”

“…There was mild paresthesia, but the patient felt no pain. The recurrence of the tumor is frequent (5-40%) and is caused by the tumor growth de-novo or the incomplete excision [13,15].…”

Sub-ungual Glomus Tumor: Study of 20 Cases

“…Two surgical approaches are described in literature-transungual and periungual and transungual approach is described as classical 1,2,4,[6][7][8][9] . This retrospective study reviewed the results of subungual glomus tumors of hand treated by surgical excision.…”