Long-Term Clinicodermoscopic and Histopathological Findings in Onychopapilloma: Outcomes of Surgical Excision and Clinical Monitoring Without Therapeutic Intervention

BACKGROUND Onychopapilloma is a benign nail unit tumor with variable clinicodermoscopic features that may mimic malignant nail lesions. Data on clinicodermoscopic–histopathological correlations and long-term outcomes are limited. OBJECTIVE To characterize clinicodermoscopic and histopathological features, identify factors associated with postoperative recurrence and nail dystrophy, and describe long-term outcomes after surgical excision or clinical monitoring without therapeutic intervention. MATERIALS AND METHODS The authors retrospectively evaluated 37 patients with onychopapilloma between 2016 and 2025. Fourteen underwent longitudinal excisional biopsy with histopathological confirmation; 23 had compatible clinicodermoscopic findings and were monitored without medical or procedural intervention. RESULTS The mean age was 55.5 years, and the thumb was the most commonly affected digit (56.7%). Predominant dermoscopic findings were longitudinal erythronychia/leukonychia (62.0%), splinter hemorrhages (59.4%), distal subungual hyperkeratotic mass (54.1%), and distal V-shaped onycholysis (51.4%). Histopathology showed acanthosis (78.6%), hyperkeratosis (71.4%), papillomatosis (50.0%), and parakeratosis (42.9%). Postoperative recurrence occurred in 28.6% of surgically treated patients; recurrent lesions had greater mean transverse width ( p < .05). No clinical progression occurred during a mean 4.37-year follow-up in monitored patients. CONCLUSION Onychopapilloma showed characteristic clinicodermoscopic and histopathological features. In carefully selected patients with typical, stable lesions, structured clinical and dermoscopic monitoring without immediate intervention may be reasonable.