Benign Nail Tumors

　　What causes benign nail tumors?

　　1. Mucous Cyst:It is the degenerative change of the distal phalangeal connective tissue.

　　2. Subungual exostosis:In fact, it is not a true exostosis outside the bone, but a parietal growth of normal bone.

　　3. Fibroids are common in patients with nodular sclerosis.

　　4. Epidermoid cysts on the nail bed:It occurs at past traumatic sites.

　　Malignant potential of benign tumors. Some benign tumors may undergo malignant transformation, and once they become malignant, the consequences are the same as those of malignant tumors. Tumors that are more prone to malignant transformation include benign pancreatic tumors, thyroid adenomas, breast fibroids, uterine tumors, flat bone tumors in the gastrointestinal tract, fibroids in soft tissues, synovial tumors, and ligament fibromas. These tumors should also be treated promptly upon discovery.

　　1. Mucous Cyst

　　A small asymptomatic cystic lesion forms between the distal phalangeal joint and the nail, presenting in shades of flesh to red, smooth, shiny, and nearly transparent. If located above the nail bed, it can cause the nail to indent. The cyst is approximately 1-2mm in size and can extend to the entire length of the nail. The size of the cyst varies over time; after the fluid inside the cyst is drained, the cyst shrinks, and occasionally, bleeding may occur, resulting in a black appearance.

　　2, Subungual exostosis

　　Rare, mostly occurring in the thumb, presenting as a firm mass under the nail and at the distal end of the nail, often misdiagnosed as a wart; X-ray examination can confirm the diagnosis.

　　3, Fibroma

　　They can be single or multiple, usually located around the nail or under the nail, and the matrix fibers can cause the nail to become significantly thin, even destroying the nail plate.

　　4, Pigmented nevus

　　The junctional nevus in the matrix can cause longitudinal pigmented bands on the nail plate, which can occur at any age, persist after onset, and a few can become malignant.

　　5, Glomus tumors

　　Rare, often located under the nail (dermal part of the nail bed), blue small lesions can be seen through the nail plate. After being pressed, they present with acute, sharp, and severe radiating pain as their characteristic.

　　6, Pyogenic granuloma

　　It is commonly an overgrowth of granulation tissue similar to suppurative granuloma, especially when in ingrown toenails. Malignant melanoma can also present with a suppurative granuloma appearance.

　　7, Keratoacanthoma

　　Those occurring under the nails are different from those in other locations, with local redness and swelling of the fingertips, pain gradually worsening, with rapid progression in the first few weeks, the nail plate being lifted and separated from the nail bed, and a scab-like small nodule appearing at the edge. Underneath, the affected phalanx has compressive necrosis. The tissue appearance is similar to that of common locations, and sometimes it can be misdiagnosed as squamous cell carcinoma.

　　8, Intrinsic chondroma

　　Rare, if they occur in the distal phalanges, they can cause the tip of the finger to swell, resembling a hammer toe, and can also manifest as chronic paronychia or significant deformation of the nail.

　　9, Epidermal buds

　　They are usually very small and can only be seen under a microscope, generally without any自觉 symptoms, but occasionally they can grow large enough to destroy the nail plate.

　　10, Nail bed tumor (onychomatrixoma)

　　The index finger, middle finger, and ring finger can be affected by one or several nails, showing yellow longitudinal strips of varying widths, with cracking and bleeding at the proximal end. The affected nails have significant ridges, and there is a tendency to curve in cross-section, with the degree of curvature increasing with the degree of yellowness. After the nail is torn off, the tumor shows that it comes from the nail plate, and the nail appears shallowly funnel-shaped, with a large amount of filamentous projections at the proximal end.

　　11, Nail bed epidermal cyst

　　Pain can be caused by cysts compressing phalanges.

　　It is generally believed that various benign tumors, due to injury and consumption of body fluids and yin, often belong to yin deficiency with internal heat. Therefore, in terms of diet adjustment, it is advisable to avoid foods with spicy, warm, dry, and hot properties, and to eat less greasy foods; while foods with cold properties should be eaten less or not at all. The dietary taboos for cancer patients vary with different types of diseases, such as nasopharyngeal cancer patients, who should avoid spicy, warm, dry, and fried and roasted foods, as well as dog meat, mutton, pepper, fennel, etc.; gastric cancer patients should avoid spicy, dry foods, cinnamon, mustard, chili, etc.; esophageal cancer patients should avoid old pork and old duck meat; liver cancer patients should avoid mother pork and eat less leek. In summary, dietary taboos should be appropriate; blind dietary taboos can lead to malnutrition and affect the recovery of the disease. The maintenance of life depends on various nutrients in food. The main problem for cancer patients is nutritional disorder, and improving the patient's nutrition is the most important measure in cancer treatment.

　　What tests should be done for benign nail tumors:

　　Nail bed tumor: Histopathology: Epithelial strands and irregular epithelial columns from the nail bed, or lobes extending into the dermis, with some areas where epithelial strands anastomose and wrap around the stroma surrounding the tumor. Epithelial strands are composed of basal cells and 2-3 layers of keratinocytes. Keratinocytes centrally芽生的 keratinocytes develop into an incomplete keratinization cell layer, with some strands having cavities, resulting in pits on the epidermal surface. The stroma surrounding the tumor comes from the dermis, containing a loose connective tissue composed of many fibroblasts and a few elastic fibers.

　　1, Foods beneficial for benign nail tumors

　　Eat more vegetables, and the diet should include 50% raw vegetables and fruits. Also, consume nuts, seeds, whole wheat, and yogurt. Refer to the next section on cancer for dietary therapy.

　　2, Foods to avoid for benign nail tumors

　　Avoid animal products, dairy products, salt, sugar, and white flour products. Also, do not eat processed foods as they do not contain enzymes, are difficult to digest, and produce toxic substances in the colon and blood.

　　Precautions before the treatment of benign nail tumors:

　　1, Mucous cysts can be completely removed or the fluid in the cyst can be aspirated with a syringe and several drops of triamcinolone (Kenalog) added, but they can recur.

　　2, The subungual exostosis can be surgically removed by excising the distal phalanx.

　　3, Fibroma usually does not require treatment and can be removed.

　　4, For melanocytic nevus occurring on the toe nail, it is possible to surgically remove the matrix lesion part and suture the incision edge. If it occurs on the nail, it is advisable to observe and be cautious about surgery, as pigmented lines are common in people of color and may be caused by trauma.

　　5, Osteoma requires the removal of the nail plate and the complete removal of the tumor in the nail bed.

　　6, After the excision of suppurative granuloma, histological examination should be performed.

　　7, Keratoacanthoma can be completely removed without amputation.

　　8, Cartilaginous Embolism requires the removal of cartilage tissue. Bone grafting is required if necessary.

　　9, The nail bed tumor can be removed by surgery.

　　10, The nail bed epidermal cyst can be removed.