Koenen tumors in tuberous sclerosis: a review and clinical considerations for treatment

Koenen tumors, or periungual and subungual fibromas, are a benign, cutaneous manifestation of tuberous sclerosis. They are disfiguring, painful, and challenging to treat as they frequently recur. Various laser and chemical ablation techniques have been described with variable long-term results and there is limited published literature to suggest a standard treatment. Through a review of the available literature and a successful experience with a patient with lower extremity Koenen tumor, we present treatment considerations for managing these troublesome tumors.