Cases reported "Nail Diseases"

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1/11. Solitary nodule of the great toe.

    We describe a 21-year-old woman with a subungual exostosis exhibiting both skin and nail findings. The patient presented with a firm, flesh-colored, nontender, subungual nodule in the distal nail bed of the great toe. Radiographic examination revealed focal calcification of the nodule, with direct communication to the underlying phalanx. Subungual exostosis should be considered in the differential diagnosis of any digital mass. Surgical excision, followed by curettage of the base, is the treatment of choice.
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ranking = 1
keywords = exostosis
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2/11. Subungual exostosis of the third toe.

    Subungual exostosis is a variant of osteochondroma that appears as a pinkish nodule under the free end of the nail plate. It becomes symptomatic when large enough to disrupt the overlying nail on the digit or through mechanical irritation of the exostosis from physical activity. Appropriate workup of such a lesion is important, because many cases of subungual exostosis are initially misdiagnosed by a variety of specialists, including dermatologists. With the use of history and roentgenography, subungual exostosis can be effectively diagnosed or excluded. Appropriate treatment of subungual exostosis can be selected- surgical excision of the lesion with significant cure rates achieved. Although most cases of subungual exostosis are localized to the great toe, we describe a 32-year-old woman who developed a subungual exostosis on her right third toe. Appropriate diagnostic workup and surgical treatment of the right third-toe exostosis has resulted in complete relief of symptoms with no signs of recurrence 7 months after surgery.
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ranking = 6
keywords = exostosis
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3/11. Hard palate mucosal grafts for defects of the nail bed.

    The authors present 2 children in whom a hard palate mucosal graft was used for a defect of the nail bed after resecting subungual exostosis. After the tumor was resected with the overriding nail bed, hard palate mucosa without periosteum was grafted to the nail bed defect. In both patients the graft took completely, and within 2 weeks after the operation the patients were able to enjoy activities of daily life, including athletic movement, without any symptoms. Nail growth was uneventful and was complete in 4 or 5 months after the operation without any complications. The authors think that a hard palate mucosal graft is a valid choice for a defect of the nail bed, and the mucosa does not need to be harvested with periosteum. The grafting of hard palate mucosa without periosteum to a defect of the nail bed contributes to a shorter healing time, resulting in a reduction in the period of restriction of movement in activities of daily life, and this is a great advantage in children.
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ranking = 0.5
keywords = exostosis
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4/11. Subungual exostosis following toe nail removal--case report.

    Removal of toe nail is a minor procedure that can be under ring block with no significant complications. We report the case of a young lady who developed a rapidly growing subungual exostosis on her right great toe following nail removal. Inadvertent iatrogenic injury to the nail bed and underlying phalangeal periosteum during nail removal might have triggered off rapid bone growth resulting in the large exostosis. To our knowledge, this aetiology for subungual exostosis formation has not been reported before.
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ranking = 3.5
keywords = exostosis
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5/11. Subungual exostosis: a review of 16 cases focusing on postoperative deformity of the nail.

    We reviewed the clinical features of 16 patients who underwent surgery for subungual exostosis, focusing on postoperative deformity of the nail. In 7 patients, the lesion did not destroy the nail bed and was excised with a fish-mouth-type incision. In 9 patients, the lesion destroyed the nail bed and was excised with a direct approach. In 5 of the 9 patients, artificial skin was applied after excision of the tumor because the defect of the nail bed was large. Good postoperative appearance of the nail was obtained by a fish-mouth-type incision when the tumor did not destroy the nail bed, although 2 patients had local recurrence. onycholysis occurred postoperatively when the tumor destroyed the nail bed and the defect of the nail bed was large after excision of the tumor. Secondary nail bed reconstruction may be indicated in such cases with postoperative deformity of the nail.
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ranking = 2.5
keywords = exostosis
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6/11. Subungual exostosis of the fingers.

    Subungual exostosis in the digit is an uncommon benign tumor. Only 21 (10%) of 203 cases reported in the literature occurred in the hand. We present a recent case, detailing diagnosis, pathologic findings, and management.
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ranking = 2.5
keywords = exostosis
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7/11. Dupuytren's (subungual) exostosis.

    Because it may produce a bewildering array of histologic patterns, the clinical entity of subungual exostosis (Dupuytren's exostosis), is sometimes confused with chondrosarcoma. However, this lesion is a distinct entity. It begins as a reactive growth of cellular fibrous tissue and metaplastic cartilage, which undergoes enchondral ossification. The rate of growth may be exuberant, but it is limited. We present a series of 15 cases as well as a review of the literature. Postadolescents and young adults are most commonly affected, and the majority of cases (80%) occur on the dorsal-medial aspect of the great toe. Trauma, whether chronic or acute, and infection are frequent inciting factors. The radiologic picture is consistent and can be diagnostic. In more than half our cases, chondrosarcoma was suspected initially. However, if the entire clinical picture is evaluated, the histologic findings should not lead to confusion with a malignant process. This acquired exostosis is benign; local excision is curative. However, recurrence is common (53%) after incomplete excision or when the lesion has not achieved full maturation.
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ranking = 3.5
keywords = exostosis
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8/11. Subungual osteocartilaginous exostosis.

    Subungual exostosis arises underneath the nail plate, originating from the underlying bone. The characteristic appearance of this disorder may occasionally mimic a wide variety of tumors, including subungual verrucae, endochondroma, fibroma, or amelanotic melanoma. With such a wide variety of similar-appearing tumors, optimal treatment of this disorder clearly lies in proper recognition and treatment.
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ranking = 2.5
keywords = exostosis
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9/11. Subungual epidermoid carcinoma.

    Subungual bowen's disease and squamous cell carcinoma are not as rare as has been implied by earlier literature. The course of the lesions is protracted. Clinically the diseases may mimic onychomycosis, chronic paronychia, eczema, verruca vulgaris, pyogenic granuloma, subungual exostosis, or malignant melanoma. Histologic examination is the key to diagnosis. As only two metastases have occurred in 110 patients, subungual epidermoid carcinomas should be regarded as low-grade malignancies that can be managed by conservative surgical ablation. The microscopically controlled excision technic (Mohs chemosurgery) is ideal for these tumors. amputation of the affected digit is too drastic, especially when the thumb, the most common site, is involved.
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ranking = 0.5
keywords = exostosis
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10/11. Subungual exostosis: case report and review of the literature.

    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 2:1. 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.
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ranking = 4
keywords = exostosis
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