Nail changes in tumorous skin conditions: a narrative review

Purpose: Tumorous conditions of the nail unit encompass a wide spectrum of benign and malignant lesions that present with diverse nail changes, many of which resemble one another. Early recognition of their characteristic clinical features is essential for accurate diagnosis and appropriate management. This review aims to summarize the clinical manifestations and therapeutic approaches of ten representative nail-associated tumors.Current Concepts: The discussed entities include benign tumors such as onychopapilloma, onychomatricoma, superficial acral fibromyxoma, periungual fibroma/fibrokeratoma, pyogenic granuloma, glomus tumor, digital myxoid cyst, and subungual exostosis, as well as malignant tumors such as squamous cell carcinoma and subungual melanoma. Each lesion demonstrates distinctive nail alterations: longitudinal erythronychia in onychopapilloma; a thickened, honeycombed nail plate in onychomatricoma; and a sharp-tipped periungual nodule in fibrokeratoma. Painful bluish discoloration suggests a glomus tumor, whereas ulcerated, rapidly growing vascular lesions favor pyogenic granuloma. Malignant tumors, including squamous cell carcinoma and melanoma, require heightened clinical suspicion when persistent onycholysis, nail dystrophy, or pigmentary changes with Hutchinson’s sign are observed.Discussion and Conclusion: Accurate diagnosis of nail tumors relies on careful correlation of clinical findings, dermoscopy, and histopathology. Surgical excision remains the primary treatment option for most benign and malignant nail tumors, while minimally invasive and laser-based approaches are emerging for select lesions. Understanding the diverse spectrum of nail changes in tumorous conditions enhances diagnostic precision, reduces unnecessary procedures, and facilitates timely management of potentially life-threatening malignancies.