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In this section we have spot diagnoses posted on a daily basis since June 2010, now over 4000! You can review the archived cases and read the suggested diagnoses by users and the final comment by the contributors.
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Case Number : Case 4109 - 20 Oct 2022 Posted By: Saleem Taibjee

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70M, full thickness longitudinal excision of lateral third of nail bed, left ring finger, ‘subungual fibrous papule’

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I think this is a Onychopapilloma (OP) associated with subepidermal onycholemmal cysts. The calcifications can be seen in these cysts and they are not uncommon in OP

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Saleem Taibjee


Not so many responses this time, perhaps reflecting how we all struggle with nail specimens.

So well done to Igor....

I was very grateful to Prof Eckhart Haneke for his expert opinion on this case, as follows:

"In my special onychopathology practice, this is not so uncommon. I have no doubt that it is an onychopapilloma with some secondary infection explaining the neutrophils in the distal keratotic tip of the lesion. The epithelial buds and cyst formation with a tendency to calcification are very characteristic. Some nuclear atypia is normal for onychopapillomas, particularly binucleate cells and an occasional apoptotic cell.

This is essentially a benign lesion. I would treat it as such. However, as two consulting histopathologists are not sure about the benignity I would recommend to just follow the patient once yearly. Recurrences are relatively common and not necessarily a sign of a malignant lesion."

McKee’s textbook also states: Pathology indicates papillomatous acanthosis of the distal matrix spreading to the nail bed, longitudinal canaliform dystrophy of the ventral nail plate, matrix-like metaplasia of the nail bed and distal subungual hyperkeratosis.


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Sorry, I'm late. Very interesting case, especially for a general pathologist like me. I'm learning, in this case, beacause my thought was an early SCC. Thanks, Saleem. 

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