Subungual metastases - Nail and Distal Digit
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Synopsis
Nail unit or subungual metastases are extremely rare, representing only 0.1% of cutaneous metastases. Direct extension from a bony lesion under the nail plate is the most common etiology. A nail unit metastasis may be the first presentation of a malignancy.
In a review of 133 patients with nail unit metastases, the lung was the most common primary tumor site (41%), then the kidney (11%) and the breast (9%). Other reported primary sites are the head and neck, bone (sarcoma), gastrointestinal tract organs, and liver. Lung cancer was the main primary tumor for all digit metastases, and genitourinary tract tumors were most common for metastases in the toes. The fingers are involved in 90% of nail metastases, and the thumb is most commonly involved.
Codes
ICD10CM:C79.89 – Secondary malignant neoplasm of other specified sites
SNOMEDCT:
402636006 – Malignant neoplasm of nail apparatus
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Malignant tumors (melanoma, squamous cell carcinoma)
- Benign tumors (onychomatricoma, digital fibrokeratoma, exostosis, glomus tumor, leiomyoma)
- Pyogenic granuloma
- Granulation tissue
- Myxoid cyst
- Verruca vulgaris
- Felon
- Paronychia (chronic, bacterial, drug-induced)
- Foreign body granuloma
- Gout
- Subungual hematoma
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Management Pearls
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Therapy
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References
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Last Reviewed:12/05/2019
Last Updated:02/14/2022
Last Updated:02/14/2022