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Subungual exostosis - Nail and Distal Digit
Other Resources UpToDate PubMed

Subungual exostosis - Nail and Distal Digit

Contributors: Shari Lipner MD, PhD, Bertrand Richert MD, Robert Baran MD, Susan Burgin MD
Other Resources UpToDate PubMed


Subungual exostosis is not a true tumor but a proliferation of normal bone or calcified cartilaginous remains arising in the distal phalanx. Subungual exostosis is equally common in both sexes and usually presents as a solitary lesion at a median age of 26. It most commonly affects the great toenail (80% of cases), but involvement of other toenails or, less commonly, the fingernails may occur. The right great toenail is more commonly affected than the left great toenail, presumably due to trauma. The proliferation usually elevates the nail plate, mostly at the distolateral edge, sometimes mimicking a subungual wart. The nail plate may be progressively destroyed. Half of cases are painless, but if the exostosis is large enough, tenderness may be a feature.


D16.9 – Benign neoplasm of bone and articular cartilage, unspecified

26904005 – Subungual exostosis

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Differential Diagnosis & Pitfalls

  • Subungual fibroma
  • Subungual wart
  • Onychomatricoma
  • Osteosarcoma
  • Acquired digital fibrokeratoma
  • Giant cell tumor of tendon sheath
  • Subungual Cutaneous squamous cell carcinoma
  • Epidermoid cyst
  • Myxoid cyst
  • Secondary subungual calcification due to trauma or Psoriasis
  • Ingrown toenail
  • Amelanotic melanoma
  • Osteochondroma
  • Enchondroma
  • Primary subungual calcification

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Last Reviewed:02/04/2019
Last Updated:02/21/2019
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Subungual exostosis - Nail and Distal Digit
A medical illustration showing key findings of Subungual exostosis : Exostoses, Fingernails, Nail pain, Onycholysis - lifting nail, Solitary nail or digit, Toenails
Clinical image of Subungual exostosis - imageId=2704448. Click to open in gallery.  caption: 'A pink papule on the nailbed with resultant paronychia.'
A pink papule on the nailbed with resultant paronychia.
Copyright © 2024 VisualDx®. All rights reserved.