Brief Report

Vol. 28, No. 5, 2016 655

Received March 4, 2015, Revised August 18, 2015, Accepted for publication September 21, 2015

Corresponding author: Hyun Jeong Park, Department of Dermatology, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 10 63-ro, Yeongdeungpo-gu, Seoul 07345, Korea. Tel: 82-2-3779-1230, Fax: 82-2-783-7604, E-mail: hjpark@catholic.ac.kr

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Copyright © The Korean Dermatological Association and The Korean Society for Investigative Dermatology

http://dx.doi.org/10.5021/ad.2016.28.5.655

Onychopapilloma: A Report of Three Cases Presenting with Various Longitudinal Chromonychia

Miri Kim, Eun Young Sun, Haw Young Jung, Baik Kee Cho, Hyun Jeong Park

Department of Dermatology, St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

Dear Editor:Onychopapilloma is an uncommon benign tumor of the distal matrix and nail bed characterized by localized distal subungual keratosis1. Several cases have been reported since the term ‘onychopapilloma’ was proposed by Baran and Perrin in 20001-5. Herein, we report three cases of onychopapilloma presenting with various longitudinal chromonychia.Two men and one woman with a median age of 47.8 years (range, 35∼67 years) developed onychopapilloma. The average disease duration was 15.5 months and showed great variation (range, 0.8∼48.0 months). The af-fected nails showed various chromonychia, including lon-gitudinal erythronychia, longitudinal reddish-yellow longi-tudinal chromonychia and multiple yellowish chromo-nychia (Fig. 1A∼C). All three patients reported pain, ten-derness, and cosmetic problems. Mycological evaluation, including a KOH smear, fungal culture, and histopatho-logic examination, revealed negative results. Histopatho-logically, a digitation of the epithelium parallel to the af-fected nail plate was present with abundant eosinophilic cytoplasm and irregular thickening (Fig. 1, A3∼C3). All three patients were treated with nail extraction and cur-ettage of the hyperkeratotic lesion. After post-treatment follow-up period (mean, 6.7 months), two patients showed good responses without nail deformities or re-currence, and one patient showed a partial response with persistent mild subungual hyperkeratosis (Fig. 1, A2∼C2). Most cases of onychopapilloma present as a localized lon-gitudinal ridge of the nail bed that is expanded at the dis-tal aspect as a subungual keratosis with longitudinal eryth-

ronychia2. However, onychopapilloma can also present with longitudinal melanonychia and leukonychia3,4. The patients described herein showed various degrees of chro-monychia including red, reddish-yellow, and yellow. Therefore, the color of the longitudinal ridge is not con-sistent among patients. We also suggest that a longitudinal ridge or chromonychia that extends to the proximal area is an important clinical feature of onychopapilloma. Although the pathogenesis of onychopapilloma is not fully under-stood, three hypotheses could be suggested: i) neoplastic hyperplasia of the nail bed epithelium, ii) reactive hyper-plasia of the nail bed epithelium due to chronic irritation or trauma, and iii) a concomitant response with other in-flammatory nail diseases such as lichen planus5. All of our patients complained of pain, especially tenderness when pressing the nail plate, which may have been due to the hyperkeratotic mass compressing the nail bed. We performed nail extraction and curettage of all the hy-perkeratotic lesions on the nail bed. Based on our experi-ence, surgical treatment to remove the hyperkeratotic tu-mor mass by curettage can be one of the acceptable meth-ods for improving the patient’s symptoms. Additionally, the removed tissue must undergo histopathological exami-nation to differentiate it from other benign tumors such as keratoacanthomas, inflammatory conditions such as fungal infections, and malignant conditions such as Bowen’s dis-ease or squamous cell carcinoma1. In conclusion, we reported three cases of onychopapillo-ma presenting with diverse clinical features including chromonychia of various colors, onycholysis, and hemor-rhagic spots. To our knowledge, onychopapilloma has

Brief Report

656 Ann Dermatol

Fig. 1. Clinical appearances of three cases of onychopapilloma. (A) Longitudinal reddish-yellow colored chromonychia was seen on the left thumbnail (patient 1). (A2) Post-treatment clinical view (after one month). (B) Multiple longitudinal yellowish chromonychia with marked subungual hyperkeratosis was seen on the right thumbnail (patient 2). (B2) Post-treatment clinical view (after 7 months). (C) Multiple longitudinal red streaks were seen on the left thumbnail. (C2) Post-treatment clinical view (after 12 months). (A1∼C1) The nail plate was extracted and 2 mm punch biopsy and curettage were performed on the nail bed (arrows). (A3∼C3) There was acanthosis of the epithelium of the nail bed (A3, B3), a digitation of the epithelium parallel to the nail plate (A3) and a thickened epithelium (C3) (H&E, ×100).

never been reported in the Korean dermatological literature. We hope that when patients present with longitudinal chromonychia with tenderness, dermatologists should be aware of the possibility of onychopapilloma.

ACKNOWLEDGMENT

This research was supported by the Basic Science Research program and Creative Materials Discovery Program through the National Research Foundation of Korea (NRF), which is funded by the Ministry of Education, Science and Technology and the Ministry of Science, ICT and Future Planning

(2015R1C1A2A01055073, 2016M3D1A1021387).

REFERENCES

1. Baran R, Perrin C. Longitudinal erythronychia with distal

subungual keratosis: onychopapilloma of the nail bed and

Bowen's disease. Br J Dermatol 2000;143:132-135.2. Baran R, Perrin C. Localized multinucleate distal subungual

keratosis. Br J Dermatol 1995;133:77-82.

3. Criscione V, Telang G, Jellinek NJ. Onychopapilloma pre-senting as longitudinal leukonychia. J Am Acad Dermatol

2010;63:541-542.

Brief Report

Vol. 28, No. 5, 2016 657

Received April 21, 2015, Revised August 18, 2015, Accepted for publication September 21, 2015

Corresponding author: Weon Ju Lee, Department of Dermatology, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Korea. Tel: 82-53-420-5838, Fax: 82-53-426-0770, E-mail: weonju@knu.ac.kr

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/ licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Copyright © The Korean Dermatological Association and The Korean Society for Investigative Dermatology

Fig. 1. (A) The initial lesion is a subungual hyperkeratotic nodule on the right little fingertip. (B) A hyperkeratotic and crusted nodule is seen after laser treatment. (C) An erythematous swollen nodule is seen after wide excision.

4. Miteva M, Fanti PA, Romanelli P, Zaiac M, Tosti A. Onycho-papilloma presenting as longitudinal melanonychia. J Am

Acad Dermatol 2012;66:e242-e243.

5. Richert B, Iorizzo M, Tosti A, André J. Nail bed lichen planus associated with onychopapilloma. Br J Dermatol

2007;156:1071-1072.

http://dx.doi.org/10.5021/ad.2016.28.5.657

Subungual Verrucous Carcinoma of the Right Little Finger with Underlying Bony Invasion

Hyun Bo Sim, Soo Yuhl Chae, Yong Hyun Jang, Seok-Jong Lee, Do Won Kim, Weon Ju Lee

Department of Dermatology, Kyungpook National University School of Medicine, Daegu, Korea

Dear Editor:A 36-year-old man with a 2-month history of a hyper-keratotic nodule on the right little fingertip was transferred to our hospital (Fig. 1A). In our hospital, over 4 months, dye laser treatment was performed 4 times based on the

initial diagnosis of subungual verruca. However, the le-sion did not improve (Fig. 1B). Ultrasonography, radiog-raphy, magnetic resonance imaging (MRI), and three-di-mensional (3D)-computed tomography (CT) showed os-teolysis at the distal edge of the distal phalanx (Fig. 2A∼