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By Lawrence A. Schiffman, DO, and Stephen
M. Schleicher, MD
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CASE:
A 23-year-old man presents for evaluation of an asymptomatic growth under his right great toenail. He states that the lesion has been slowly increasing in size for several years and that he is now seeking treatment because of the cosmetic disfigurement. Physical examination reveals toenails that appear normal except for a ridge alongside the right great toenail. Noted is a shiny, pink, firm, subungual tumor protruding beneath the nail of this toe. Palpation does not elicit tenderness.
WHAT IS YOUR DIAGNOSIS?
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Biopsy revealed that the lesion was a digital fibroma. These
benign connective tissue growths usually present as a smooth,
dome-shaped, solitary nodule, most often on the great toe.
Multiple lesions may be associated with tuberous sclerosis.
Antecedent trauma is sometimes correlated with onset. Digital
fibromas can exert pressure on the nail matrix, resulting
in distortion of the nail. Treatment, when requested for
either cosmesis or relief of discomfort, entails surgical
excision of the tumor. |
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Dr. Schleicher is director of DermDx Centers
and a clinical instructor of dermatology at the Philadelphia
College of Osteopathic Medicine, at Kings College in Wilkes-Barre,
Pennsylvania, and at Arcadia University in Glenside, Pennsylvania.
He is also a member of the EMERGENCY MEDICINE
editorial board. Dr. Schiffman is currently a resident at
St. John's Episcopal Hospital in Far Rockaway, New York.
Emerg Med 38(3):39, 2006
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