The patient is a healthy librarian who noticed a reddish area under the left thumb nail ~ 3 months ago. Shortly after that, the distal portion of the nail become yellowish. She has not history of trauma and the area is not painful
O/E: There is erythema noted medically in the nail bed and the nail plate is onycholytic. No abnormality of the nail plate is noted other than the yellowish area and possibly a Beau's line. The patient feels that the red area has migrated medially.
Clinical Image:
My thoughts: I am concerned that there may be a tumor under the nail plate. The fact that it is painless argues against glomus tumor. I welcome suggestions.
Thank you,
DJE
Professor E. Haneke writes: "I think you should remove the onycholytic part of the nail as he patient is in an age group where you can never rule out a malignancy of the nail bed. After nail plate removal I would recommend a biopsy from the underlying nail bed."
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