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Onycholemmal Horn: A Case Series and Literature Review
Eckart Haneke1,2,3, Nilton Di Chiacchio4, Nilton Gioia Di Chiacchio4
1Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Introduction:
Onycholemmal horn is an exceptionally rare benign tumor of the nail unit characterized by slow growth and a broad differential diagnosis that includes malignant tumors, particularly squamous cell carcinoma. Recognition of its characteristic clinicopathologic features is essential for establishing the correct diagnosis.
Case Presentation:
We report a clinicopathologic series of four cases of onycholemmal horn, including the first case originally described in the literature. All patients presented with slowly growing, painless keratotic lesions involving the lateral nail fold and/or nail bed. Histopathologic examination demonstrated a compact orthokeratotic horn arising from acanthotic epithelium with abrupt onycholemmal keratinization and no evidence of viral cytopathic changes. Complete surgical excision was performed in all clinically managed cases.
Conclusion:
Onycholemmal horn is a rare benign tumor that may clinically mimic malignant nail neoplasms. Recognition of its characteristic clinical and histopathologic features is essential to establish the correct diagnosis, avoid unnecessary aggressive treatment, and improve the recognition of this uncommon nail tumor.
