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JAMA Oncology Clinical Challenge
October 31, 2019

Subungual Mass in a Middle-aged Woman

Author Affiliations
  • 1Department of Dermatology, Peking Union Medical College Hospital, Beijing, China
JAMA Oncol. 2019;5(12):1799-1800. doi:10.1001/jamaoncol.2019.4500

A 54-year-old woman presented with a 7-year history of a painful subungual mass of the right thumb. The lesion was initially believed to be an infection; however, results of both mycological and bacteriologic examinations were unremarkable. The patient had no notable medical history, including dyskeratosis congenita, trauma, sun exposure, radiation exposure, chemical exposure to tar or arsenic or exposure to minerals, chronic immunosuppression, or chronic infection. Physical examination revealed a subungual nodule with some exudation and crusts. The distal nail plate had been destroyed and showed onycholysis with obvious separation from the nail bed (Figure, A). Pertinent laboratory results (complete blood cell count, liver panel, kidney panel) were within normal limits. Lesional biopsy was also performed (Figure, B and C).

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