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Nail Clipping Diagnosis of Onychomatricoma

Mariya Miteva, MD; D ébora Cadore de Farias, MD; Martin Zaiac, MD; Paolo Romanelli, MD; Antonella Tosti, MD
Arch Dermatol. 2011;147(9):1118-1119. doi:10.1001/archdermatol.2011.240.
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Onychomatricoma is a benign nail matrix tumor clinically characterized by a thickened, overcurved nail plate with multiple holes at the distal margin of the nail plate.1 Histologically, onychomatricoma is a fibroepithelial tumor of the nail matrix that presents as characteristic epithelial digitations in the nail plate.2,3 Since in onychomatricoma the nail plate is perforated by the fibroepithelial projections of the tumor,4 we suggest that a nail clipping may be an easy method to point to the correct diagnosis. Immunohistochemical analysis for cytokeratin may be added to highlight the matrix epithelium.

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Figure. Rationale for diagnosing onychomatricoma on a nail clipping. A, Clinical presentation of the honeycomb cavities evident at the frontal margin of the thickened nail plate. B, Schematic representation of the nail clipping specimen used for histologic analysis and containing the honeycomb cavities in a thickened overcurved yellow nail. C, Transverse section demonstrates increased nail thickness with cavitations filled with serous material and surrounded by a layer of epithelium (hematoxylin-eosin, original magnification ×4). D, Epithelium matrix of the tumor projections indicated by arrows (anticytokeratin antibody, original magnification ×40).

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