My Instructive Nail Case

In this presentation, the speaker discusses a case involving a 25-year-old female patient who presented with a blue growth under her right third fingernail, which had been slowly increasing in size for about 10 years. The lesion exhibited tenderness and bleeding when trauma occurred. Upon examination, the growth exhibited a violet-blue coloration and was accompanied by distal onycholysis and hyperkeratosis. The differential diagnosis included potential vascular lesions, squamous cell carcinoma, and glomus tumors. A biopsy was recommended, including a digital block and partial nail plate avulsion. Pathological analysis revealed large telangiectatic blood vessels and hemorrhage, leading to a diagnosis of subungual angiokeratoma, a rare condition with only a few cases documented in the literature. The speaker explains two clinical presentations of nail unit angiokeratomas: a longitudinal pigment band and a larger warty tumor, both related to chronic trauma or irritation. The need for proper differential diagnosis is emphasized due to the similarity of symptoms to other conditions, such as nail unit hemorrhage, melanocytic lesions, or even squamous cell carcinoma. The speaker concludes by advising clinicians to include subungual or solitary subungual angiokeratoma in their differential diagnoses for subungual pigmented lesions.