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Authors: Dr Senhong Lee, Clinical Trials Fellow, and Dr Anne Howard, Dermatologist, Skin and Cancer Foundation Inc, Carlton, Melbourne, VIC, Australia. DermNet NZ Editor in Chief: Adjunct A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand. Copy edited by Gus Mitchell/Maria McGivern. April 2019.
Onychomatricoma is a rare, benign fibroepithelial tumour of the nail matrix .
Onychomatricoma typically affects Caucasian women, with a peak incidence in the fifth decade of life. It is rarely observed in children .
The exact pathophysiology of onychomatricoma is unknown, although it could be precipitated by trauma [3,4].
Onychomatricoma more commonly affects the fingers than the toes. It could involve either a single digit or multiple digits simultaneously [2,5].
Onychomatricoma is typically slow-growing and painless. Its classic clinical features include [1,4,5]:
Dermoscopic features of onychomatricoma include perforations in the distal portion of the nail plate, haemorrhagic striae, as well as white longitudinal grooves corresponding to the nail plate channels .
Onychomatricoma may be complicated by onychomycosis, so both conditions can coexist [1,5]. Delayed diagnosis and treatment are not uncommon due to unfamiliarity with onychomatricoma .
Onychomatricoma is diagnosed based on its characteristic clinical features supplemented by dermoscopy, imaging, and histopathology .
Imaging may be considered to guide clinical decisions before excision if the presentation is non-specific or unclear . Imaging modalities that could help with diagnosing onychomatricoma include [5,7]:
Histopathological evaluation could be performed on either nail clippings or a resected tumour, which is considered the gold standard [1,4–7]:
Immunohistochemistry although helpful, is not routinely required in typical cases .
Common differential diagnoses of onychomatricoma include:
The definitive treatment for onychomatricoma is complete surgical excision .
Onychomatricoma typically resolves without local recurrence with complete surgical excision [2,4].
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