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]
Bowen disease variant^[16]
Subungual keratoacanthoma^[17]
Yellow nail syndrome^[18]
Onychomycosis^[19]: 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.^[20]
Onychocytic matricoma and malignant counterpart onychocytic carcinoma^[21]: 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.

Workup

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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. [QxMD MEDLINE Link].
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Media Gallery

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

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Author

Annie Wester, MD, MS Resident Physician, Department of Dermatology, Vanderbilt University Medical Center

Disclosure: Nothing to disclose.

Coauthor(s)

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.

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, Council for Nail Disorders, Houston Dermatological Society, International Society of Hair Restoration Surgery, Texas Dermatological Society, Texas Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Former 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: Alpha Omega Alpha, American Academy of Dermatology, Association of Military Dermatologists, Phi Beta Kappa, 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: Received income in an amount equal to or greater than $250 from: Elsevier; WebMD<br/>Served as a speaker for various universities, dermatology societies, and dermatology departments.

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.

Onychomatricoma Differential Diagnoses

Diagnostic Considerations

References

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