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Correspondence |

Onychomatricoma: Clinical and Sonographic Findings

Rosamary Soto, MD; Ximena Wortsman, MD; Yamile Corredoira, MD
Arch Dermatol. 2009;145(12):1461-1462. doi:10.1001/archdermatol.2009.312.
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Onychomatricoma (OM) is a rare benign tumor of the nail matrix clinically characterized by longitudinal bands of yellow thickening of the nail plate with transverse overcurvature and splinter hemorrhages.14 The diagnosis is often difficult, and many cases are misdiagnosed and erroneously treated.

High-resolution variable-frequency ultrasonography, a noninvasive imaging technique that uses tunable frequency probes in the range of 7 to 15 MHz, has been proven to clearly recognize the nail unit components as well as abnormalities inside the nail bed with high definition.5 This variable-frequency capacity allows the operator to adjust the penetration depth of the ultrasound wave to the desired level; therefore, it is possible to obtain a complete representation of the nail structure from the surface of the dorsal plate to the bone margin of the distal phalanx, including blood flow characteristics in real time. Moreover, color Doppler spectral curve analysis can demonstrate the arterial or venous nature of the flow.

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Figure 1. Clinical aspect of a lesion in the middle fingernail of a 69-year-old man. Note the thickening and dark yellow coloration of the nail plates, longitudinal bands, and splinter hemorrhages.

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Figure 2. Ultrasonographic images of the fingernail shown in Figure 1 in the longitudinal axis. A, Normal ultrasonographic anatomy of the nail. B, Longitudinal oblique ultrasonographic view of the nail shows a hypoechoic solid lesion with hyperechoic linear dots (unlabeled arrows) affecting the matrix and deforming the plates, compatible with an onychomatricoma. In both panels, dp indicates dorsal plate; dph, distal phalanx; m, matrix; nb, nail bed; pl, plates; and vp, ventral plate.

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