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June 1992

Painful Solitary Subungual Nodule

Author Affiliations

Oregon Health Sciences University, Portland, and Portland Veterans Affairs Medical Center

Arch Dermatol. 1992;128(6):852. doi:10.1001/archderm.1992.01680160137024

REPORT OF A CASE  An 11-year-old girl presented with a 2-year history of a growing, painful lesion under the fourth toenail of her right foot. She could not recall any preceding trauma to the toe and was in good general health.Findings from her physical examination disclosed a 6-mm pearly, firm, subungual papule protruding from the distal edge of the right fourth toenail (Fig 1). The lesion was firm and fixed on palpation, with discrete margins and overlying telangiectasia. There was no ulceration. The remainder of her digits and nails were normal. A diagnostic test was performed (Fig 2), followed by excision. Representative pathologic sections are shown in Figs 3 and 4.What is your diagnosis?

DIAGNOSIS:  Subungual exostosis (SE).

HISTOPATHOLOGIC FINDINGS  Tissue sections stained with hematoxylin-eosin showed a fragment of bone capped by cartilage (Fig 3). The cartilage had numerous chondrocytes with variably shaped