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Acquired digital fibrokeratoma - Nail and Distal Digit
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Acquired digital fibrokeratoma - Nail and Distal Digit

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Contributors: Shari Lipner MD, PhD, Belinda Tan MD, PhD, Susan Burgin MD
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Synopsis

Acquired digital fibrokeratoma (ADF), or acral fibrokeratoma, is an uncommon, benign neoplasm that presents as a solitary asymptomatic papule on the digit (finger or toe), nail bed, or periungual area of middle-aged adults. Nail tumors are most often seen in middle-aged men and are localized to the great toe.

The etiology is unknown, but ADF is thought to develop after local trauma or subclinical injury.

Codes

ICD10CM:
D23.9 – Other benign neoplasm of skin, unspecified

SNOMEDCT:
110986000 – Acquired digital fibrokeratoma

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Supernumerary digit – Present at birth, usually on the medial / ulnar side of the fifth digit.
  • Periungual fibromas – These lesions, also called Koenen tumors, are sometimes associated with tuberous sclerosis and develop in late childhood around toenails or, less often, around fingernails; periungual fibromas have histologic findings quite similar to those of ADF.
  • Verruca vulgaris – Viral-induced neoplasms often have brown / purple dots (thrombosed capillaries) centrally.
  • Eccrine poroma – A proliferation of ductal epithelium, presenting usually as a sessile vascular papule of acral skin surrounded by an indentation ("moat and hillock").
  • Lobular capillary hemangioma (pyogenic granuloma) – Rapidly growing, exophytic, and pedunculated vascular papule that is prone to easy bleeding.
  • Cutaneous horns or corns – Hyperkeratosis and flat surface; sometimes painful.
  • Dermatofibroma – Rarely seen on palmoplantar surfaces, this type of lesion has a characteristic tethering of the overlying epidermis to the underlying fibrotic lesion that creates a "dimple" with lateral compression (Fitzpatrick sign).
  • Cutaneous squamous cell carcinoma – Variable presentation. Usually lacks the collarette of scale present in acral digital fibrokeratoma. Hyperkeratosis and nail loss may be present.
  • Aggressive digital papillary adenocarcinoma – A rare malignant tumor, presenting as a solitary asymptomatic swelling or cystic nodule; differentiated chiefly by histologic examination.

Best Tests

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Management Pearls

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Therapy

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References

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Last Reviewed: 12/07/2018
Last Updated: 12/07/2018
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Acquired digital fibrokeratoma - Nail and Distal Digit
See also in: Overview
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Acquired digital fibrokeratoma : Fingers, Smooth papule, Solitary nail or digit, Toes
Clinical image of Acquired digital fibrokeratoma
Smooth, flesh-colored, pedunculated papule on the lateral nail fold of the digit. Minimal onycholysis is present.
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