Siham Mansouri, Amina Kissou, Meriem Meziane, Badr Hassam

Dermatology Department, University Hospital Ibn Sina, Rabat, Morocco

Corresponding author: Dr. Siham Mansouri, E-mail: siham-mnsr@hotmail.fr

Submission: 30.05.2019; Acceptance: 27.08.2019

DOI: 10.7241/ourd.20202.33

Cite this article: Mansouri S, Kissou A, Meziane M, Hassam B. Onychopapilloma. Our Dermatol Online. 2020;11(2):214-215.

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A 35-year-old male, skin phototype IV, presented with a 5-year history of a nail alteration of his right thumb. He denied previous trauma, pain or discomfort. The clinical examination found an erythronychia associated with some long filiform haemorrhages on the distal part of the nail (Fig. 1). In dermoscopy, the pink band measured 1.7 mm, it interrupted the lunula and we clearly distinguished filiform haemorrhages (Fig. 2a). The dermatoscopy of the distal edge demonstrated localized subunal hyperkeratosis (Fig. 2b). There was no painful area on palpation. The evaluation of the other fingernails and toenails was normal. Partial surgical avulsion of the nail plate revealed a tumor and a total excision was made. We proceeded to a histological examination that revealed a papillomatous epithelial lining (Fig. 3), the seat of epidermal metaplasia with the presence of a keratogenous pseudo-layer. The keratinocytes were multinucleate without cytonuclear atypia. The diagnosis of onychopapilloma has been established.

Figure 1: Localised Longitudinal erythronychia.
Figure 2: (a) Dermoscopy: red streak (White arrow) with splinter hemorrhages (red arrow). (b) Dermoscopy of the free edge of the nail plate shows a subungual keratotic mass (red arrow).
Figure 3: HES coloration (x200), keratogenous zone and Vesicular nuclei with binucleation.

Onychopapilloma is a rare benign tumor of the nail bed and the distal matrix. It was first described by Barran and Perrin in 1995. The tumor is especially seen in young women. The lesion is often monodactylic, essentially reaching the thumb [1]. They rarely cause severe pain, although Delvaux et al reported pain in 40% [2]. Longitudinal erythronychia is the most common presentation of onychopapilloma but it may have different clinical presentations like melanonychia, and leukonychia. [3,4]. Onychopapilloma can also present with splinter hemorrhages without any other lesion. On dermoscopy, the band begins in the lunula with a proximal convex border and contains one or multiple splinter hemorrhages associated with subungual keratotic mass [3]. Onychopapilloma often causes a distal V-shaped onycholysis.

The main differential diagnoses are: glomus tumor, melanoma, Bowen’s disease, squamous cell carcinoma, subungual wart, Darier disease (polydactylous longitudinal erythronychia), lichen planus and splinter hemorrhages which seen after trauma.

Complete excision should be performed during a nail biopsy for diagnosis and treatment to avoid trauma from two procedures. Histologic findings are characterized by the presence of acanthosis, papillomatosis and metaplasia of the distal matrix and the nail bed with multinucleated cells without cellular atypia [5]. The tumor rarely recurs.

Onychopapilloma is a rare benign tumor of the nail bed and the distal matrix. Management of monodactylous erythronychia should be based on the patient’s symptoms or changes in the lesion. Sudden onset or changing erythronychia should be biopsied. Dermoscopy is very important in the differential diagnosis of the nail erythronychia.


The examination of the patient was conducted according to the Declaration of Helsinki principles.


1. Baran R, Perrin C. Localized multinucleate distal subungual keratosis. Br J Dermatol. 1995;133:77-82.

2. Delvaux C, Richert B, Lecerf P, AndréJ. Onychopapillomas:a 68-case series to determine best surgical procedure and histologic sectioning. J Eur Acad Dermatol Venereol. 2018;32:2025-30.

3. Tosti A, Schneider SL, Ramirez-Quizon MN, Zaiac M, Miteva M. Clinical, dermoscopic, and pathologic features of onychopapilloma:A review of 47 cases. J Am Acad Dermatol. 2016;74:521-6.

4. Halteh P, Magro C, Scher RK, Lipner SR. Onychopapilloma Presenting as Leukonychia:Case Report and Review of the Literature. Skin Appendage Disord. 2017;2:89-91.

5. Baran R, Perrin R. Longitudinal erythronychia with distal subungual keratosis:onychopapilloma of the nail bed and Bowen’s disease. Br J Dermatol. 2000;143:132-5.


Source of Support: Nil.

Conflict of Interest: None declared.

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