Onychomatricoma - Causes, Symptoms, and Treatment

Introduction

Onychomatricoma is a rare non-spreading tumor of the nails. The affected sites are the first three fingers of the hands and the big toe. The tumor was first reported in 1992 by Baran and Kint. The condition can be confused with other nail diseases, such as fungal infections, because these conditions resemble each other clinically. The finger-like projections are formed on the nail plate. There is a change in the structure and appearance of the nail plate. The nail plate has yellowish discoloration, and the nail might be distorted and thickened.

The condition is difficult to diagnose because of its rarity and unknown etiology. The key to diagnosing is the histopathological characteristics. The percentage of reappearing of the tumor is less. Further research is required to get a complete knowledge of the condition and further treatment modalities. The article discusses onychomatricoma, its causes, pathophysiology, histopathology, symptoms, diagnosis, and treatment.

What Are the Causes of Onychomatricoma?

The reasonable cause or etiology of the condition has yet to be fully understood. Several points can lead to the formation of the condition. The factors leading to the development of the condition are as follows:

• Genetic Factors: An individual with a family member with the condition can indicate the possibility of developing the condition. The genes responsible for the development of the condition are not fully known.

• Trauma or Injury: An injury or trauma to the nail can trigger the formation of onychomatricoma. While doing mechanical work, an individual can have repeated injuries on the nail matrix. This might lead to the development of the nail matrix tumor.

• Clonal Proliferation: The condition can develop from clonal proliferation. The cells present in the nail matrix get multiplied and proliferated. This will lead to the formation of the tumor.

• Hormonal Imbalance: Some studies revealed hormonal imbalances can cause nail matrix tumor formation. However, further research is required on hormone imbalance in giving rise to the condition.

What Are the Risk Factors for Onychomatricoma?

Rare non-cancerous consists of specific risk factors associated with the condition's formation. The specific risk factors are as follows:

• Age: Middle-aged 30 to 40 years people and older adults above 50 years are at high risk of developing the condition.

• Gender: Both men and women are affected by the condition, but women are more prone to develop the condition.

• Family History: The more the family members suffer from the condition, the more the possibility of developing the condition.

• Nail Disorders: People suffering from nail conditions such as nail inflammation increase the development of onychomatricoma.

• Chronic nail trauma.

What Are the Signs and Symptoms of Onychomatricoma?

The tumor is non-cancerous, non-spreading, and slow-growing. The condition affects the nail and nail matrix. Both the nails of the hands and toes are affected, but the fingernails are more prone to the condition. Onychomatricoma could involve a single nail or multiple nails. The signs and symptoms of onychomatricoma are as follows:

• Alteration in Nail Structure: There will be a change in the structure and appearance of the affected nail. The affected nail will be discolored and thickened.

• Nail Distortion: The affected nail will be distorted in the structure. The shape of the nail will be irregular or non-symmetrical.

• Irregularity of Nail Surface: The texture of the affected nail will be rough. The nail's surface will be irregular, with longitudinal grooves or depressions.

• Nail Discoloration: There will be a change in the color of the affected nail. The affected nail's color is mainly yellow, but it can also be brown.

• Pain: Generally, the tumor is painless. Sometimes, the tumor is associated with pain and discomfort. When the tumor gets enlarged, it may put pressure on the surrounding tissues and cause pain and discomfort.

How Is Onychomatricoma Diagnosed?

The proper diagnosis of onychomatricoma has yet to be well known. However, the clinical examination and histopathological analysis can help the healthcare professional diagnose the condition. The steps for diagnosing onychomatricoma are as follows:

• Clinical Examination: The healthcare provider will physically examine the affected nail and check for the signs and symptoms like nail distortion, irregularities, and discoloration.

• Imaging Studies: The doctor might advise the patient to get an imaging test such as magnetic resonance imaging (MRI) and computed tomography scan (CT) to check the extent of the tumor. Whether the tumor puts pressure on the neighboring structures or tissues, these tests will show finger-like projections.

• Histopathological Examination: It is the accurate and main examination to diagnose onychomatricoma. The doctor will take a small biopsy from the affected nail and send it for a pathological laboratory test. The histopathological features show irregular keratinocytes and nail clippings filled with serous material. The histopathological features of the resected tumor shows a thickened nail plate, and fibroepithelial projections from the nail matrix go to the nail plate.

How Is Onychomatricoma Treated?

The treatment of the non-cancerous tumor is surgical excision. Care should be taken while performing surgery so that the aesthetics of the nails should be preserved. The treatment modalities of onychomatricoma are as follows:

• Surgical Excision: The healthcare provider will inject a local anesthetic solution into the affected area. The tumor is surgically removed, leaving behind healthy tissue. After the surgical resection of the tumor, the open wound is closed using sutures.

• Nail Reconstruction: The procedure is done to restore the function of the affected area. It includes artificial nails or any other cosmetic nail treatment.

• Regular Follow-Up: The healthcare professional will do a regular follow-up to check for any recurrence.

What Are the Complications of Onychomatricoma?

The complications of onychomatricoma are as follows:

• Nail infection may occur during or post-surgery.

• Nail deformity or aesthetic nail concern.

• Onychomatricoma can recur again.

• Change in nail texture.

• Tumor pressure on neighboring structures.

Conclusion

Onychomatricoma is a rare non-cancerous and non-spreading tumor. The tumor may put pressure on the neighboring structures. There may be a change in the nail texture, color, and appearance. A histopathological examination can diagnose the condition. The condition will be cured by surgical resection of the tumor. Regular follow-ups should be maintained to check or monitor the recurrence rate of the tumor. Future research is required to know the cause and treatment modalities of the condition.