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Periungal fibroma or is it nail tuft?

:bang:I would love advice about how to treat this, as it's technical name eludes me! I have a 35 year old lady, who has had no trauma that she can think of, and in the last 10 days her right 1st toe nail became sore and has started to disfigure. Observation shows a slightly oblong growth under the length of the 1st nail , continuing down into the matrix area. At this stage it is about 4mm across the width of the nail, but has started to grow out of the matrix too. It has a visible vasculature, is skin coloured, very firm to touch, and not sore on palpation....unless I dig it with a black's file!!. The nail from where it has grown beneath has split and now been cut away. It does not appear to be a verruca pedis, as it has a smooth surface and not sore to pinch. Can someone please suggest a course of treatment or any other diagnosis, or where else to look for some answers??? Many Thanks, Kym

 

Re: Periungal fibroma or is it nail tuft?

Hello Kym,

Sounds interesting. Could you perhaps post a picture?

Regards,

Mifiros

 

Re: Periungal fibroma or is it nail tuft?

Growing that fast it may wel be a subungual VP, highly unlikeny that it is a fibroma, shoudln't grow that quick.
If it's growing at such a rate, I'd have the lady off to the GP. for a biopsy asap

 

Re: Periungal fibroma or is it nail tuft?

Quite agree. Might also be a mucoid cyst. However, non-pigmented melanoma, squamous cell carcinoma or sarcoma should not be overlooked. Is there any relevant medical Hx?

As Adrian advises, biopsy is indicated ASAP.

Bill

 

Re: Periungal fibroma or is it nail tuft?

Thanks for all the info, unfortunately, I don't have the ability here at work to send a photo,...but that's a great idea! Shall send her to the GP for a biopsy. I really appreciate the input. Cheers, Kym

 

Re: Periungal fibroma or is it nail tuft?

Thanks for the help, the lump in question has now been biopsied and is a benign soft tissue chondroma which will be surgically removed due to it's size now! Kym

 

Re: Periungal fibroma or is it nail tuft?

The biopsy result was a benign soft tissue chondroma.....just incase you were wondering! Kym

 

Re: Periungal fibroma or is it nail tuft?

The biopsy result was a benign soft tissue chondroma.....just incase you were wondering! Thanks, Kym

 

Re: Periungal fibroma or is it nail tuft?

To all who replied to my question, many thanks! Interestingly, the lesion was biopsied and the results were then thought to be begnin. A surgical consult and further histology was done because the surgeon was not happy with what was going on in the lesion, then xrays and a trip to Peter Mc Callum for imaging, and the lesion was found to be a rare form of CHONDROSARCOMA and the right big toe has now been amputated. The surgeon told the patient that due to it's aggressive nature she would have been dead in 6 months as it would have invaded her limb and hip and currently there is no cancer treatment that it responds to, and amputation is the only way. Thanks again and what an interesting case! Cheers, Kym:drinks

 

Re: Periungal fibroma or is it nail tuft?

Thanks for the follow-up Kym! Cases liek this make you fel all warm and fuzy, knowing that you made a difference to someone's life!
Kudos to you!!

 

Re: Periungal fibroma or is it nail tuft?

Well done Kym for your management of this case. It makes a good reminder that anything that we, or the patient, may consider suspicious should not be shrugged off as another trivial corn or vp or simple exostosis, and any doubt about the lesion should be the trigger to further investigations.

Regards,

Mifiros

 

Hello and help

I have a 46yr afrocarribbean lady with a benign periungal fibroma. (diagnosed by Dermatologist)
It's on the left hallux and is/was growing from the base of the nail. It has split the nail longitudinally from the base to the distal edge. No other med Hx - is a healthy individual.

Her footwear regardless of what it is, irritates and causes pain.

The option being considered is to surgically remove the whole nail and the fibroma. (TNA)

Any other thoughts or advice - anything is welcome.

Kiwi AD :sinking:

 

"Kiwi AD"

Having dealt with a few of these, the best course of action is surgical removal. Normally you need to reflect back the nail fold to completely excise the lesion otherwise recurrence is inevitable. The nail plate may recover afterwards.

I haven't yet found any conservative methods that work!


Soton Pod

 

'Soton Pod'

Thanks for getting back to me. Will let you know the outcome!

Kiwi AD

 

Hi

I agree with Soton pod. However, given that the patient is AfroCaribbean it's worth bearing in mind the possibility of hypertrophic scarring. If she is prone to this it could be worse than the p/cx.

All the best

Bill

 

Cheers Bill,

Hadn't considered the the scaring aspect. Bt she is healthy, not over weight as some afrocaribbeans can be and has no other history of any significance.

Fingers crossed
Thanks for your imput

Kiwi AD :drinks