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Onychomatricoma Differential Diagnoses

  • Author: Annie Wester, MS; Chief Editor: William D James, MD  more...
 
Updated: Oct 21, 2015
 
 

Diagnostic Considerations

On the basis of current reports, onychomatricomas must be a consideration in the differential diagnosis of suspicious subungual lesions in elderly white patients, regardless of sex. Other considerations in the differential diagnosis include the following:

  • Verrucae vulgaris - This and squamous cell carcinoma variants of this can look very similar to onychomatricoma and may require biopsy to differentiate.
  • Fibrokeratomas[13] : These lack the fibroepithelial projections and cavitations of the nail plate that are seen with onychomatricomas. These may arise around the nail plate and would also have a collarette of slightly raised skin that encircles the base
  • Onycholemmal horns[14]
  • Periungual fibromas[15]
  • Yellow nail syndrome[18]
  • Onychomycosis: This does not manifest with longitudinal overcurvature.
  • Subungual melanoma: Pigmented onychomatricoma has been reported and has the potential for misdiagnosis as melanoma. Biopsy maybe required to differentiate.[19]
  • Onychocytic matricoma and malignant counterpart onychocytic carcinoma[20] : It presents with localized thickening of the nail plate. Histologically, it is a benign acanthoma of onychocytes. It is composed of a basal compartment with a varying admixture of prekeratogenous cells and keratogenous cells. Endokeratinization originating in the deep portion of the tumor and nests of prekeratogenous and keratogenous cells in concentric arrangement are characteristic features. It can be classified according to its histopathologic type (acanthotic, papillomatous, or keratogenous with retarded maturation) and pigmentation (pigmented, hypopigmented, melanocytic, or nonpigmented). The term pachymelanonychia is used in one paper to define the 2 clinical features of the tumor. Pachyonychia indicate a localized thickening of the nail plate, and melanonychia indicate its longitudinal pigmented band.
 
 
Contributor Information and Disclosures
Author

Annie Wester, MS Loyola University, Chicago Stritch School of Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Rashid M Rashid, MD, PhD Director, Mosaic Clinic Hair Transplant Center of Houston

Rashid M Rashid, MD, PhD is a member of the following medical societies: American Academy of Dermatology, Texas Medical Association, Texas Dermatological Society, International Society of Hair Restoration Surgery, Council for Nail Disorders, Houston Dermatological Society

Disclosure: Nothing to disclose.

James W Swan, MD Associate Professor of Medicine, Division of Dermatology, Loyola University Stritch School of Medicine; Attending Physician, Loyola University Medical Center; Attending Physician, Section of Dermatology, Hines Veterans Affairs Medical Center

James W Swan, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Contact Dermatitis Society, Chicago Dermatological Society

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: American Medical Association, Alpha Omega Alpha, Association of Military Dermatologists, American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Phi Beta Kappa

Disclosure: Nothing to disclose.

Jeffrey Meffert, MD Associate Clinical Professor of Dermatology, University of Texas School of Medicine at San Antonio

Jeffrey Meffert, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Association of Military Dermatologists, Texas Dermatological Society

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Richard K Scher, MD Adjunct Professor of Dermatology, University of North Carolina at Chapel Hill School of Medicine; Professor Emeritus of Dermatology, Columbia University College of Physicians and Surgeons

Richard K Scher, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, American Medical Association, Association of Military Surgeons of the US, International Society for Dermatologic Surgery, Noah Worcester Dermatological Society, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

References
  1. Baran R, Kint A. Onychomatrixoma. Filamentous tufted tumour in the matrix of a funnel-shaped nail: a new entity (report of three cases). Br J Dermatol. 1992 May. 126(5):510-5. [Medline].

  2. Haneke E, Franken J. Onychomatricoma. Dermatol Surg. 1995 Nov. 21(11):984-7. [Medline].

  3. Kint A, Baran R, Geerts ML. The onychomatricoma: an electron microscopic study. J Cutan Pathol. 1997 Mar. 24(3):183-8. [Medline].

  4. Perrin C, Langbein L, Schweizer J, Cannata GE, Balaguer T, Chignon-Sicart B, et al. Onychomatricoma in the light of the microanatomy of the normal nail unit. Am J Dermatopathol. 2011 Apr. 33(2):131-9. [Medline].

  5. Goettmann S, Zaraa I, Moulonguet I. Onychomatricoma with pterygium aspect: unusual clinical presentation. Acta Derm Venereol. 2006. 86(4):369-70. [Medline].

  6. Perrin C, Baran R. Onychomatricoma with dorsal pterygium: pathogenic mechanisms in 3 cases. J Am Acad Dermatol. 2008 Dec. 59(6):990-4. [Medline].

  7. Burchette JL, Pham TT, Higgins SP, Cook JL, Soler AP. Expression of cadherin/catenin cell--cell adhesion molecules in a onychomatricoma. Int J Surg Pathol. 2008 Jul. 16(3):349-53. [Medline].

  8. Cañueto J, Santos-Briz Á, García JL, Robledo C, Unamuno P. Onychomatricoma: genome-wide analyses of a rare nail matrix tumor. J Am Acad Dermatol. 2011 Mar. 64(3):573-8, 578.e1. [Medline].

  9. Di Chiacchio N, Tavares GT, Tosti A, Di Chiacchio NG, Di Santis E, Alvarenga L, et al. Onychomatricoma: epidemiological and clinical findings in a large series of 30 cases. Br J Dermatol. 2015 May 12. [Medline].

  10. Tosti A, Piraccini BM, Calderoni O, Fanti PA, Cameli N, Varotti E. Onychomatricoma: report of three cases, including the first recognized in a colored man. Eur J Dermatol. 2000 Dec. 10(8):604-6. [Medline].

  11. Rashid RM, Swan J. Onychomatricoma: benign sporadic nail lesion or much more?. Dermatol Online J. 2006. 12(6):4. [Medline].

  12. Piraccini BM, Antonucci A, Rech G, Starace M, Misciali C, Tosti A. Onychomatricoma: first description in a child. Pediatr Dermatol. 2007 Jan-Feb. 24(1):46-8. [Medline].

  13. Fraga GR, Patterson JW, McHargue CA. Onychomatricoma: report of a case and its comparison with fibrokeratoma of the nailbed. Am J Dermatopathol. 2001 Feb. 23(1):36-40. [Medline].

  14. DiMaio DJ, Cohen PR. Trichilemmal horn: case presentation and literature review. J Am Acad Dermatol. 1998 Aug. 39(2 Pt 2):368-71. [Medline].

  15. Yasuki Y. Acquired periungual fibrokeratoma--a proposal for classification of periungual fibrous lesions. J Dermatol. 1985 Aug. 12(4):349-56. [Medline].

  16. Baran R, Perrin C. Bowen's disease clinically simulating an onychomatricoma. J Am Acad Dermatol. 2002 Dec. 47(6):947-9. [Medline].

  17. Patel MR, Desai S. Subungual keratoacanthoma in the hand. J Hand Surg [Am]. 1989 Jan. 14(1):139-42. [Medline].

  18. Bokszczanin A, Levinson AI. Coexistent yellow nail syndrome and selective antibody deficiency. Ann Allergy Asthma Immunol. 2003 Nov. 91(5):496-500. [Medline].

  19. Wynes J, Wanat KA, Huen A, Mlodzienski AJ, Rubin AI. Pigmented Onychomatricoma: A Rare Pigmented Nail Unit Tumor Presenting as Longitudinal Melanonychia That Has Potential for Misdiagnosis as Melanoma. J Foot Ankle Surg. 2015 Jul-Aug. 54 (4):723-5. [Medline].

  20. Spaccarelli N, Wanat KA, Miller CJ, Rubin AI. Hypopigmented onychocytic matricoma as a clinical mimic of onychomatricoma: clinical, intraoperative and histopathologic correlations. J Cutan Pathol. 2013 Jun. 40(6):591-4. [Medline].

  21. Soto R, Wortsman X, Corredoira Y. Onychomatricoma: clinical and sonographic findings. Arch Dermatol. 2009 Dec. 145(12):1461-2. [Medline].

  22. Sanchez M, Hu S, Miteva M, Tosti A. Onychomatricoma has channel-like structures on in vivo reflectance confocal microscopy. J Eur Acad Dermatol Venereol. 2014 Nov. 28 (11):1560-2. [Medline].

  23. Graves MS, Anderson JK, LeBlanc KG Jr, Sheehan DJ. Utilization of Mohs micrographic surgery in a patient with onychomatricoma. Dermatol Surg. 2015 Jun. 41 (6):753-5. [Medline].

  24. Perrin C, Baran R, Pisani A, et al. The onychomatricoma: additional histologic criteria and immunohistochemical study. Am J Dermatopathol. 2002 Jun. 24(3):199-203. [Medline].

  25. Miteva M, Cadore de Farias D, Zaiac M, Romanelli P, Tosti A. Nail clipping diagnosis of onychomatricoma. Arch Dermatol. 2011 Sep. 147(9):1117-8. [Medline].

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Courtesy of Dr. Militello.
Note the woodworm-like features. Courtesy of Dr. Militello.
 
 
 
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