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Tırnak Altı Lezyonlarında Cerrahi Yaklaşım

Yıl 2021, Cilt: 5 Sayı: 3, 421 - 428, 25.12.2021
https://doi.org/10.29058/mjwbs.905342

Öz

Amaç: Tırnak bölgesinde birçok farklı doku bir arada olduğundan görülen tümöral lezyonlar oldukça
çeşitlidir. Pigmente veya nonpigmente olabilen benign tümörler genellikle daha sıklıkla gözükür ancak
sadece muayene ile benign-malign tümör ayrımının yapılması zordur. Bunun dışında tümöral olmayan
tırnak hastalıklarının da ayırıcı tanıda yer alması gerektiği unutulmamalıdır.
Gereç ve Yöntemler: Bu çalışmada 2009-2020 tarihleri arasında tırnakta kitle şikayetiyle iki farklı
merkezdeki plastik cerrahi kliniklerine başvuran 12 hasta dahil edilmiştir. Hastaların klinik bulguları,
yapılan tedaviler ve sonuçları değerlendirilmiştir.
Bulgular: Her iki plastik cerrahi kliniğine ortalama yaşları 45,9 (34-58) olan 12 hasta başvurmuştur.
Hastalardan 11’i cerrahi tedavi edilmiş, bir hasta tedavi edilmemiştir. Histopatolojik tanı olarak bir hastada
ganglion kisti, beş hastada glomus tümörü ve beş hastada lineer nevüs tanısı konulmuştur. Opere
edilen 11 hastanın 10’unda hastaların tedavi sonucu çok iyi olarak değerlendirilmiştir. Glomus tümörü
olan bir hastada nüks görülmüş ve hasta tekrar opere edilmiştir ve nüks gözlenmemiştir.
Sonuç: Tırnak yatağındaki lezyonlar sıklıkla hastalar tarafından göz ardı edilmektedir. Hem benign,
hem de malign lezyonlar benzer bulgular verebileceğinden tanı için biyopsi alınması şarttır. Uygun
tedavi biyopsi sonucuna göre belirlenmelidir.

Kaynakça

  • 1. Dominguez-Cherit J, Chanussot-Deprez C, Maria-Sarti H, Fonte-Avalos V, Vega-Memije E, Luis-Montoya P. Nail unit tumors: a study of 234 patients in the dermatology department of the "Dr Manuel Gea Gonzalez" General Hospital in Mexico City. Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al]. 2008 Oct;34(10):1363-71.
  • 2. Mundada P, Becker M, Lenoir V, Stefanelli S, Rougemont AL, Beaulieu JY, et al. High resolution MRI of nail tumors and tumor-like conditions. Eur J Radiol. 2019 Mar;112:93-105.
  • 3. Haneke E. Important malignant and new nail tumors. J Dtsch Dermatol Ges. 2017 Apr;15(4):367-86.
  • 4. Wortsman X, Wortsman J, Soto R, Saavedra T, Honeyman J, Sazunic I, et al. Benign tumors and pseudotumors of the nail: a novel application of sonography. J Ultrasound Med. 2010 May;29(5):803-16.
  • 5. Richert B, Lecerf P, Caucanas M, Andre J. Nail tumors. Clin Dermatol. 2013 Sep-Oct;31(5):602-17.
  • 6. Haneke E. Nail Unit Tumors - Benign Tumors. In: Singal A, Neema S, Kumar P, editors. Nail Disorders A Comprehensive Approach. New York, NY: CRC Press/Taylor & Francis Group; 2019. p. 360-97.
  • 7. Singal A, Bisherwal K. Melanonychia: Etiology, Diagnosis, and Treatment. Indian Dermatol Online J. 2020 Jan-Feb;11(1):1-11.
  • 8. Gradinaru TC, Mihai M, Beiu C, Tebeica T, Giurcaneanu C. Melanonychia - Clues for a Correct Diagnosis. Cureus. 2020 Jan 10;12(1):e6621.
  • 9. Nevares-Pomales OW, Sarriera-Lazaro CJ, Barrera-Llaurador J, Santiago-Vazquez M, Lugo-Fagundo N, Sanchez JE, et al. Pigmented Lesions of the Nail Unit. Am J Dermatopathol. 2018 Nov;40(11):793-804.
  • 10. Morey VM, Garg B, Kotwal PP. Glomus tumours of the hand: Review of literature. J Clin Orthop Trauma. 2016 Oct-Dec;7(4):286-91.
  • 11. Pandey CR, Singh N, Tamang B. Subungual Glomus Tumours: Is Magnetic Resonance Imaging or Ultrasound Necessary for Diagnosis? Malays Orthop J. 2017 Mar;11(1):47-51.
  • 12. Civan O, Gunturk OB, Ozaksar K, Cavit A, Ozcanli H. Glomus tumors of the nail bed: topographic anatomy and an algorithmic approach based on the topography. Handchir Mikrochir Plast Chir. 2020 Jun;52(3):202-6.
  • 13. Chae JB, Ohn J, Mun JH. Dermoscopic features of digital mucous cysts: A study of 23 cases. J Dermatol. 2017 Nov;44(11):1309-12.
  • 14. Ferreli C, Caravano M, Fumo G, Rongioletti F. Digital myxoid cysts: 12-year experience from two Italian Dermatology Units. G Ital Dermatol Venereol. 2018 Dec;153(6):847-54.
  • 15. Brown RE, Zook EG, Russell RC, Kucan JO, Smoot EC. Fingernail deformities secondary to ganglions of the distal interphalangeal joint (mucous cysts). Plast Reconstr Surg. 1991 Apr;87(4):718-25.
  • 16. Esson GA, Holme SA. Treatment of 63 Subjects With Digital Mucous Cysts With Percutaneous Sclerotherapy Using Polidocanol. Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al]. 2016 Jan;42(1):59-62.
  • 17. Haneke E. Nail Unit Tumors - Malignant Tumors. In: Singal A, Neema S, Kumar P, editors. Nail Disorders A Comprehensive Approach. New York, NY: CRC Press/Taylor & Francis Group; 2019. p. 399-428.
  • 18. Reilly DJ, Aksakal G, Gilmour RF, Gyorki DE, Chauhan A, Webb A, et al. Subungual melanoma: Management in the modern era. J Plast Reconstr Aesthet Surg. 2017 Dec;70(12):1746-52.
  • 19. Faico-Filho KS, Martins RS, Santos CL, Poles WA, Mello RB, Moura-Faico MM. Total melanonychia of 20 nails as a rare manifestation of vitamin B12 deficiency. JAAD Case Rep. 2020 Apr;6(4):372-3.
  • 20. O'Connor EA, Dzwierzynski W. Longitudinal melonychia: clinical evaluation and biopsy technique. J Hand Surg Am. 2011 Nov;36(11):1852-4.
  • 21. Littleton TW, Murray PM, Baratz ME. Subungual Melanoma. Orthop Clin North Am. 2019 Jul;50(3):357-66.
  • 22. Reinders EFH, Klaassen KMG, Pasch MC. Transungual Excision of Glomus Tumors: A Treatment and Quality of Life Study. Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al]. 2020 Jan;46(1):103-12.
  • 23. Sechi A, Alessandrini A, Patrizi A, Starace M, Caposiena Caro RD, Vara G, et al. Ultrasound features of the subungual glomus tumor and squamous cell carcinomas. Skin Res Technol. 2020 Jun 25.
  • 24. Nambi GI, Varanambigai TKA. Excision of Subungual Glomus Tumor by Subungual Approach: A Useful Yet Underutilized Technique. J Cutan Aesthet Surg. 2019 Jul-Sep;12(3):187-90.
  • 25. Asmar G, Mati T, Pop IA, Falcone MO. The 'shark mouth' flap approach for digital glomus tumours in 24 patients: technique and clinical outcomes. J Hand Surg Eur Vol. 2020 Feb;45(2):153-9.
  • 26. Monteagudo-Sanchez B, Luina-Mendez L, Mosquera-Fernandez A. Dermoscopic Features of a Digital Myxoid Cyst. Acta Dermatovenerol Croat. 2019 Jun;27(2):129-30.
  • 27. Hsiung W, Huang HK, Chen TM, Chang MC, Wang JP. The outcome of minimally invasive surgery for digital mucous cyst: a 2-year follow-up of percutaneous capsulotomy. J Dermatolog Treat. 2020 Jun 1:1-7.

Surgical Approach in Subungual Lesions

Yıl 2021, Cilt: 5 Sayı: 3, 421 - 428, 25.12.2021
https://doi.org/10.29058/mjwbs.905342

Öz

Aim: Since there are many different tissues in the nail area, the tumoral lesions seen are quite diverse.
Benign tumors that can be pigmented or nonpigmented are usually seen more often, but it is difficult to
distinguish between benign and malignant tumors by examination alone. Apart from this, it should be
kept in mind that non-tumoral nail diseases should also be included in the differential diagnosis.
Material and Methods: In this study, 12 patients who presented to two different centers with the
complaint of a mass in the nail between 2009-2020 were included. Clinical findings, treatments and
results of the patients were evaluated.
Results: Twelve patients with a mean age of 45.9 (34-58) applied to both clinics. 11 of the patients were
treated surgically, one patient was not treated. Histopathological diagnosis was ganglion cyst in one
patient, glomus tumor in five patients and linear nevus in five patients. In 10 of the 11 operated patients,
the treatment result of the patients was evaluated as very good. Recurrence was observed in one
patient with glomus tumor and the patient was re-operated and no recurrence was observed.
Conclusion: Lesions in the nail bed are often overlooked by patients. Since both benign and malignant
lesions may give similar findings, biopsy is essential for diagnosis. The appropriate treatment should be
determined according to the biopsy result.

Kaynakça

  • 1. Dominguez-Cherit J, Chanussot-Deprez C, Maria-Sarti H, Fonte-Avalos V, Vega-Memije E, Luis-Montoya P. Nail unit tumors: a study of 234 patients in the dermatology department of the "Dr Manuel Gea Gonzalez" General Hospital in Mexico City. Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al]. 2008 Oct;34(10):1363-71.
  • 2. Mundada P, Becker M, Lenoir V, Stefanelli S, Rougemont AL, Beaulieu JY, et al. High resolution MRI of nail tumors and tumor-like conditions. Eur J Radiol. 2019 Mar;112:93-105.
  • 3. Haneke E. Important malignant and new nail tumors. J Dtsch Dermatol Ges. 2017 Apr;15(4):367-86.
  • 4. Wortsman X, Wortsman J, Soto R, Saavedra T, Honeyman J, Sazunic I, et al. Benign tumors and pseudotumors of the nail: a novel application of sonography. J Ultrasound Med. 2010 May;29(5):803-16.
  • 5. Richert B, Lecerf P, Caucanas M, Andre J. Nail tumors. Clin Dermatol. 2013 Sep-Oct;31(5):602-17.
  • 6. Haneke E. Nail Unit Tumors - Benign Tumors. In: Singal A, Neema S, Kumar P, editors. Nail Disorders A Comprehensive Approach. New York, NY: CRC Press/Taylor & Francis Group; 2019. p. 360-97.
  • 7. Singal A, Bisherwal K. Melanonychia: Etiology, Diagnosis, and Treatment. Indian Dermatol Online J. 2020 Jan-Feb;11(1):1-11.
  • 8. Gradinaru TC, Mihai M, Beiu C, Tebeica T, Giurcaneanu C. Melanonychia - Clues for a Correct Diagnosis. Cureus. 2020 Jan 10;12(1):e6621.
  • 9. Nevares-Pomales OW, Sarriera-Lazaro CJ, Barrera-Llaurador J, Santiago-Vazquez M, Lugo-Fagundo N, Sanchez JE, et al. Pigmented Lesions of the Nail Unit. Am J Dermatopathol. 2018 Nov;40(11):793-804.
  • 10. Morey VM, Garg B, Kotwal PP. Glomus tumours of the hand: Review of literature. J Clin Orthop Trauma. 2016 Oct-Dec;7(4):286-91.
  • 11. Pandey CR, Singh N, Tamang B. Subungual Glomus Tumours: Is Magnetic Resonance Imaging or Ultrasound Necessary for Diagnosis? Malays Orthop J. 2017 Mar;11(1):47-51.
  • 12. Civan O, Gunturk OB, Ozaksar K, Cavit A, Ozcanli H. Glomus tumors of the nail bed: topographic anatomy and an algorithmic approach based on the topography. Handchir Mikrochir Plast Chir. 2020 Jun;52(3):202-6.
  • 13. Chae JB, Ohn J, Mun JH. Dermoscopic features of digital mucous cysts: A study of 23 cases. J Dermatol. 2017 Nov;44(11):1309-12.
  • 14. Ferreli C, Caravano M, Fumo G, Rongioletti F. Digital myxoid cysts: 12-year experience from two Italian Dermatology Units. G Ital Dermatol Venereol. 2018 Dec;153(6):847-54.
  • 15. Brown RE, Zook EG, Russell RC, Kucan JO, Smoot EC. Fingernail deformities secondary to ganglions of the distal interphalangeal joint (mucous cysts). Plast Reconstr Surg. 1991 Apr;87(4):718-25.
  • 16. Esson GA, Holme SA. Treatment of 63 Subjects With Digital Mucous Cysts With Percutaneous Sclerotherapy Using Polidocanol. Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al]. 2016 Jan;42(1):59-62.
  • 17. Haneke E. Nail Unit Tumors - Malignant Tumors. In: Singal A, Neema S, Kumar P, editors. Nail Disorders A Comprehensive Approach. New York, NY: CRC Press/Taylor & Francis Group; 2019. p. 399-428.
  • 18. Reilly DJ, Aksakal G, Gilmour RF, Gyorki DE, Chauhan A, Webb A, et al. Subungual melanoma: Management in the modern era. J Plast Reconstr Aesthet Surg. 2017 Dec;70(12):1746-52.
  • 19. Faico-Filho KS, Martins RS, Santos CL, Poles WA, Mello RB, Moura-Faico MM. Total melanonychia of 20 nails as a rare manifestation of vitamin B12 deficiency. JAAD Case Rep. 2020 Apr;6(4):372-3.
  • 20. O'Connor EA, Dzwierzynski W. Longitudinal melonychia: clinical evaluation and biopsy technique. J Hand Surg Am. 2011 Nov;36(11):1852-4.
  • 21. Littleton TW, Murray PM, Baratz ME. Subungual Melanoma. Orthop Clin North Am. 2019 Jul;50(3):357-66.
  • 22. Reinders EFH, Klaassen KMG, Pasch MC. Transungual Excision of Glomus Tumors: A Treatment and Quality of Life Study. Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al]. 2020 Jan;46(1):103-12.
  • 23. Sechi A, Alessandrini A, Patrizi A, Starace M, Caposiena Caro RD, Vara G, et al. Ultrasound features of the subungual glomus tumor and squamous cell carcinomas. Skin Res Technol. 2020 Jun 25.
  • 24. Nambi GI, Varanambigai TKA. Excision of Subungual Glomus Tumor by Subungual Approach: A Useful Yet Underutilized Technique. J Cutan Aesthet Surg. 2019 Jul-Sep;12(3):187-90.
  • 25. Asmar G, Mati T, Pop IA, Falcone MO. The 'shark mouth' flap approach for digital glomus tumours in 24 patients: technique and clinical outcomes. J Hand Surg Eur Vol. 2020 Feb;45(2):153-9.
  • 26. Monteagudo-Sanchez B, Luina-Mendez L, Mosquera-Fernandez A. Dermoscopic Features of a Digital Myxoid Cyst. Acta Dermatovenerol Croat. 2019 Jun;27(2):129-30.
  • 27. Hsiung W, Huang HK, Chen TM, Chang MC, Wang JP. The outcome of minimally invasive surgery for digital mucous cyst: a 2-year follow-up of percutaneous capsulotomy. J Dermatolog Treat. 2020 Jun 1:1-7.
Toplam 27 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Sağlık Kurumları Yönetimi
Bölüm Araştırma Makalesi
Yazarlar

Ali Gökkaya 0000-0003-2710-9615

Burçin Acuner 0000-0001-8728-279X

Metin Görgü 0000-0001-9077-2976

Yayımlanma Tarihi 25 Aralık 2021
Kabul Tarihi 11 Kasım 2021
Yayımlandığı Sayı Yıl 2021 Cilt: 5 Sayı: 3

Kaynak Göster

Vancouver Gökkaya A, Acuner B, Görgü M. Tırnak Altı Lezyonlarında Cerrahi Yaklaşım. Med J West Black Sea. 2021;5(3):421-8.

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