Subungual Acantholytic Dyskeratotic Acanthoma: A Case Report and Literature Review

Subungual acantholytic dyskeratotic acanthoma is a rare benign tumor of epidermal keratinocytes characterized by acantholysis and dyskeratosis. Only 7 other cases have been published in the literature.

A 29-year-old male presented with painful erythronychia and onycholysis of the left thumbnail. He worked as an electrician and was ambidextrous. Two months prior to the onset, he reported completing a mechanical task which led to repeated and sustained pressure to his left thumb. The clinical diagnosis was onychopapilloma, and a longitudinal excision was performed to remove the tumor. However, on histopathological examination, the primary features were hyperkeratosis, acantholysis, and dyskeratosis, consistent with a final diagnosis of subungual acantholytic dyskeratotic acanthoma.

Nail trauma was reported by our case as a preceding feature, and this has not been described previously. Pain may accompany nail changes in the presentation of this tumor. Although subungual acantholytic dyskeratotic acanthoma is a benign tumor, it caused disruption in productivity, and our case highlights the need for timely access to specialist nail services.