Management of subungual keratoacanthoma

Two-year follow-up of a subungual keratoacanthoma treated by curettage has shown partial reconstitution of the bony defect in the distal phalanx. Previous recommendations for treatment of this tumor have been divergent, ranging from conservative local excision to aggressive amputation. Review of the 18 cases reported in the literature reveals that 86% of the lesions ultimately treated by curettage did not recur. Two patients with recurrent disease after curettage were cured by eventual conservative amputation. Aggressive ablative surgery as the initial intervention for this benign condition should be discouraged.