Onychocytic matricoma presenting as pachymelanonychia longitudinal. A new entity (report of five cases)

Among the tumors of the epidermal appendages, only rare tumors have been proved as differentiating in the direction of the nail. Beside onychomatricoma, we report a new matrical tumor of the nail: onychocytic matricoma (acanthoma of the nail matrix producing onychocytes). The main differential diagnosis of onychocytic matricoma is seborrheic keratosis. However, if attention is paid to the nature of the different layers of the tumor and the peculiar microanatomy of the nail matrix, the differentiation is not difficult. Onychocytic matricoma is a localized (monodactylous) longitudinal melanonychia which is slightly raised. The term pachymelanonychia is used to define the 2 clinical features of the tumor. Pachyonychia indicate a localized thickening of the nail plate, and melanonychia indicate its longitudinal pigmented band. Onychocytic matricoma is composed of a basal compartment with a varying admixture of prekeratogenous cells and keratogenous cells. Endokeratinization originating in the deep portion of the tumor and nests of prekeratogenous and keratogenous cells in concentric arrangement are a characteristic feature. Three major patterns can be identified as follows: acanthotic, papillomatous, keratogenous type with retarded maturation. Given the peculiar thickening of the nail plate observed both in pigmented onychomatricoma and onychocytic matricoma, the term pachymelanonychia longitudinal could be proposed to specify clinically these 2 lesions, which the clinician sometimes mistakes for melanoma.