HPI: 67 yo man with 1 - 2 month hx of a nail bed tumor. The overlying nail has been destroyed. Lesion is asymptomatic.
O/E: 8 mm diameter flesh-colored tumor left thumb nail. No pigment. Lesion is solid, not friable.
Clinical Photos
Pathology: Hyperkeratosis, parakeratosis, epidermal hyperplasis. There are ectatic blood vessels in an edematous and fibrotic stroma. Iin the DDx is an unusual traumatized hemangioma or subungual fibroma.
Microscopic Photos courtesy of Deon Wolpowitz, Boston University SkinPath
Diagnosis: Benign nail bed tumor, not otherwise specified. Presented for ideas.
Questions: What is your diagnosis, and how would you approach this lesion?
Plan: The patient has been referred for defintive surgery to a Mohs surgeon.