Review Question - QID 3596

The clinical presentation is consistent with a subungual exostosis. Tumor resection with an osteotomy through the base of the tumor is the most appropriate treatment.

Osteochondromas are the most common benign bone tumor. They are a benign chondrogenic lesion derived from aberrant cartilage which arises from the perichondral ring. One common presentation of an osteochondroma is a subungual exostosis, which most commonly occurs on the hallux. With tumor removal and local wound care, patient's have an excellent result as long as the nail matrix is not injured.

Campanelli et al. describe a case report showing excellent clinical imaging of a 12-year-old girl with a subungual exostosis treated at their institution. They describe their experience with this benign tumor and the excellent clinical outcomes which can be expected with conservative surgical treatment.

Schnirring-Judge et al. review benign bone tumors of the foot and ankle and describe their experience treating osteochondromas of the hallux. They too suggest simple surgical excision rather than aggressive resection given the benign nature of this tumor.

Figure A is a clinical photo consistent with an subungual exostosis. Figure B is a radiograph showing a benign appearance of the lesion and its continuity with the medullary canal of the distal phalanx. Illustration A shows the results of this patient following surgical resection.

Incorrect Answers:
1) Not appropriate given the painful nature of the mass and that it is eroding through the skin.
2) Not appropriate to amputate a benign lesion that will be treated well with simple excision.
4&5) A benign osteochondroma doesn't need chemotherapy or radiation therapy.