Clinical Example: Nail Contour Correction After Eponychial Tumor Excision

Nail deformities may result from growths changing the contour of the germinal matrix. These may appear permanent, but normal nail plate contour can be restored if the mass effect is corrected without damaging the germinal matrix. These five cases demonstrate the recovery potential of the nail bed in this circumstance.
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Case 1.
Mucous cyst. Mucous cysts (distal interphalangeal joint synovial cysts; myxoid cysts) commonly result in longitudinal concavity of the nail plate from pressure on the germinal matrix.
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Typical secondary contour/
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These are usually filled with clear colorless gelatinous material with an appearance similar to mucous, but technically is thickened synovial liquid, not mucous. The superficial location allows the diagnosis to be confirmed with transillumination.
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Joint debridement is curative. Here, closure of the eponychial splitting incision is shown.
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Late result with restoration of normal eponychial and nail plate contour.
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Case 2.
Nail deformity from subungual bone tumor. This patient has multiple hereditary exostoses.
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Case 3.
Another mucous cyst, more centrally located. Note both the nail deformity and the thin overlying skin. Repeated cyst drainage may lead to joint infection.
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Late result with normalization of nail fold contour.
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Case 4.
Mucous cyst with contour abnormality and nail plate syrface irregularity.
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Exposure.
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Late result.
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Case 5.
Distal phalanx osteochondroma. This painless unusual benign tumor resulted in a severe nail plate concavity.
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Excision.
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Restoration of normal nail plate contour.
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