Clinical presentation
A 28-year-old female patient with a 5-year history of a nonpainful, slow-growing mass on the second right distal aspect of the phalanx noticed a nonpainful, firm, pink, dome-shaped growth elevating the nail plate 1 year ago. She had a history of accidental trauma with acrylic nails 1 year before the nail tumor. X-ray scan and soft-tissue ultrasonography (ACUSON X700; Siemens) showed hypoechogenic dermal tissue that measured 0.8 × 0.4 × 0.6 cm3 (Fig 1).
Fig 1.
A, Clinical image of subungual distal fibromyxoma. B, Clinical picture where the lunula is appreciated. C, X-ray demonstrating no bone involvement. D, Spindle and stellate-shaped cells in a myxoid stroma (CD34 stain; original magnification: ×10.).
Dermatoscopic appearance
Using pocket DL200 Hybrid (DermLite) (magnification: ×20), a nonpigmented tumor, with a pink, homogeneous color, and longitudinal, soft-pink and small, shiny, white streaks perpendicular to the nail plate were observed. Below the nail plate, a layer of white, hyperkeratotic projections, with sparse red, brown, and gray dots that were immediately adjacent, was observed. No vascular structures were seen in this patient, which is different from other publications that have reported this tumor (Fig 2).1
Fig 2.
A, Dermatoscopy image of white lines and a yellow-white crust below the distal part of the nail plate. Perpendicular, linear, white lines of the tumor on a pink, homogeneous stroma as well as sparse brown dots. B, Photograph shows a frontal view of the fibromyxoma.
Histologic diagnosis
The dermatopathology report described laminar compact hyperkeratosis, regular acanthosis, and elongated papillary processes. Superficial-medium dermis, a neoformation with spindle cell proliferations in the myxoid stroma, and no atypia or necrosis were also observed. CD34-positive cell staining was compatible with superficial acral fibromyxoma.
Key message.
Superficial acral fibromyxoma is a benign, slow-growing, periungual or subungual tumor that was first described by Fetsch et al in 2001, with approximately 314 cases reported.2, 3, 4, 5, 6 Dermatoscopic findings contribute to underdiagnosed analysis of this tumor that is identified based on several patterns reported and facilitate its challenging diagnosis compared with that of other acral tumors, including myxoid variations. Our dermatoscopy case report shows a digital fibromyxoma with no capillary patterns observed in the myxoid areas in a female patient with a history of acrylic nail trauma, and histopathology confirmed this diagnosis. No reports secondary to gel polish andsubungual acral fibromyxoma were found.
Conflicts of interest
None disclosed.
Footnotes
Funding Sources: None.
IRB approval status:
References
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