Onycholemmal horn

Onycholemmal horn is historically similar to proliferating trichilemmal tumour. Clinically the lesion has a warty appearance and histologically it consists of an epithelial proliferation with keratinocytes enlarging toward the surface and producing large amounts of keratin containing necrotic keratinocytes. There is no true crater and shoulder formation.

Keratoacanthoma

Keratoacanthoma is a fast-growing, painful lesion usually arising from the hyponychium or the lateral nail groove. In the tip of the digit it exhibits a more vertical growth pattern, rapidly reaching and eroding the bone. A marked lateral lip and keratin-filled crater are characteristic. Suprabasal keratinocytes are large, rich in glycogen, and towards the horn-filled crater often contain keratohyalin granules. Staining for p53, Ki1 and proliferating cell nuclear antigens gives a more regular peripheral staining in keratoacanthoma than in squamous cell carcinoma, but this is not clear-cut enough to make this pattern a differential diagnostic tool.

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