Dermatoscopy of subungual digital fibromyxoma (superficial acral fibromyxoma)

Abstract

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). 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).1Sialitti S. Abdelmouttalib A. Senouci K. Meziane M. Subungual acral fibromyxoma: new dermoscopic features.Our Dermatol Online. 2021; 12: 1-2Crossref Google Scholar 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 messageSuperficial 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.2Griffiths C. Barker J. Bleiker T. Chalmers R. Creamer D. Acquired disorders of the nails and nail unit.in: Rook's Textbook of Dermatology: Specific Cutaneous Structure. 9th ed. Wiley-Blackwell, 2016: 2501Crossref Google Scholar, 3Kutzer H. Kamino H. Reddy V. Pui J. Fibrous and fibrohistiocytic proliferations of the skin and tendons.in: Bologna J. Dermatology. 4th ed. Elsevier, 2018: 2071Google Scholar, 4Bostanci S. Akay B.N. Akkaya Z. et al.Superficial acral fibromyxoma.J Am Podiatr Med Assoc. 2021; 111: 17https://doi.org/10.7547/20-119Crossref Scopus (0) Google Scholar, 5Crepaldi B. Soares R. Silveira F. et al.Superficial acral fibromyxoma: literature review.Rev Bras Ortop. 2019; 54: 491-496Crossref PubMed Scopus (0) Google Scholar, 6Fetsch JF Laskin WB Miettinen M Superficial acral fibromyxoma: a clinicopathologic and immunohistochemical analysis of 37 cases of a distinctive soft tissue tumor with a predilection for the fingers and toes.Hum Pathol. 2001; 32: 704-714Crossref Scopus (187) Google Scholar 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. 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.2Griffiths C. Barker J. Bleiker T. Chalmers R. Creamer D. Acquired disorders of the nails and nail unit.in: Rook's Textbook of Dermatology: Specific Cutaneous Structure. 9th ed. Wiley-Blackwell, 2016: 2501Crossref Google Scholar, 3Kutzer H. Kamino H. Reddy V. Pui J. Fibrous and fibrohistiocytic proliferations of the skin and tendons.in: Bologna J. Dermatology. 4th ed. Elsevier, 2018: 2071Google Scholar, 4Bostanci S. Akay B.N. Akkaya Z. et al.Superficial acral fibromyxoma.J Am Podiatr Med Assoc. 2021; 111: 17https://doi.org/10.7547/20-119Crossref Scopus (0) Google Scholar, 5Crepaldi B. Soares R. Silveira F. et al.Superficial acral fibromyxoma: literature review.Rev Bras Ortop. 2019; 54: 491-496Crossref PubMed Scopus (0) Google Scholar, 6Fetsch JF Laskin WB Miettinen M Superficial acral fibromyxoma: a clinicopathologic and immunohistochemical analysis of 37 cases of a distinctive soft tissue tumor with a predilection for the fingers and toes.Hum Pathol. 2001; 32: 704-714Crossref Scopus (187) Google Scholar 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. None disclosed.