Distal digital keratoacanthoma

Subungual and periungual keratoacanthomas may occur as solitary or multiple tumours. They are rare, benign, rapidly growing, seemingly aggressive tumours usually situated beneath the distal portion of the nail bed. The lesion starts as a small, painful keratotic nodule visible beneath the free edge, growing rapidly to a 1 cm lesion within 4-8 weeks. Its typical gross appearance, as a dome-shaped nodule with a central plug of horny material filling the crater, is more obvious on an adequate histological specimen. Less frequently the tumour grows out from under the proximal nail fold, which becomes swollen and inflamed. In contrast to keratoacanthomas elsewhere, in distal digital tumors, spontaneous regression is rare.

The tumour soon erodes the bone, but reconstitution of the defect can be achieved.

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