The most commonly accepted treatment of subungual exostosis is a localized excision. Partial or total removal of the nail has traditionally be advocated to ensure complete excision of the exostosis, a nail-sparing technique that has been shown to enhance cosmetic results.3 Incomplete excision and incomplete maturation of the lesion have been reported to be responsible for almost 50% of recurrences.3 This high recurrence rate is due to difficulty in ensuring a total excision because the gradual merging of the fibrocartilage cap with the overlying nail bed makes it impossible to develop a cleavage plane5; as a result, it has been suggested that excision should only be attempted after maturation of the tumor so the cleavage plane can fully develop. Other studies claim that delaying treatment can result in elevation and deformity of the nail, pain, and secondary periungual infection.3
Conclusion
Subungual exostosis is a benign bony tumor of the distal phalanx that can cause pain and onycholysis. Radiography of the affected digit is a noninvasive way to confirm the diagnosis and should be part of the initial workup of any suspicious subungual tumor. Once identified, complete removal of the exostosis by excision has been shown to be an effective treatment with few complications.