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Hello all,

This patient is a healthy 40 year old female. She gets pedicures regularly and has noted in the last 6 months these tiny finger like projections growing in the area of her proximal nail fold. She noticed that every time the pedicurist went to trim the cuticle of her right 4th toe - it would bleed heavily.

This is something I haven't seen myself. They definitely seem vascular in nature and they sit on top of the nail plate but are not attached to it.

Also - the area of nail plate of which they sit is flat with tiny longitudinal striations.

Has anyone else seen this kind of presentation? What is the suggested treatment?

I was thinking cauterization or applying 75% silver nitrate to shrink the tissue if it's vascular.

Thanks for the help!

 

Hi,

These are classic Koenen's tumour, or periungual fibroma, benign tumours which are composed primarily of fibrous connective tissue and are incredibly vascular, so can bleed profusely. If there is multiple nail involvement this could indicate tuberous sclerosis. However, if only a single nail is involved then it is less likely to, according to these guys;

http://www.ncbi.nlm.nih.gov/pubmed/7492148

Treatment in the form of surgical excision of the lesion is the preferred treatment in symptomatic cases, i.e discomfort and/or frequent bleeding.

Hope that helps!

Cheers,
Bel

 

Absolutely. One of the few tumours in which the appearance is pathognomonic. Refer to a podiatric surgeon colleague for excision, which is generally successful.

All the best

Bill Liggins

 

Yep, do that. Sorry, I forgot to omit specifically whom to refer on to.

 

Thank you all for your help!

 

Cutaneous manifestations of tuberous sclerosis in the foot: A case study
Molly Ichikawa, DPM et al
J Int Foot Ankle [Internet]. 2022 Jun. 1 [cited 2022 Jul. 7];1(6).