Ram's Horn Nail - Giant Onychomatricoma Treated by Complete Surgical Excision- A Rare Case Report

Giant onychomatricoma is a rare fibroepithelial nail matrix tumor with only two previous reports in literature, from Mexico. An 80-year-old female patient presented with a progressively painless mass in the left great toe nail, following trauma, of 2 years duration. On examination there was a single, hard, immobile mass of size 4 × 3 × 2 cm with proximal hyperpigmentation of the left great toe nail. The mass was totally excised and a punch biopsy of nail matrix was taken. Histopathology revealed hyperkeratosis, acanthosis, multiple channels lined by flattened epithelium and fibrocollagenous tissue in horizontal orientation in deeper layers. The patient had no recurrence after 1 month. We report this case for its rare and distinct clinical presentation, characteristic histopathology and easy surgical treatment.