Acquired digital periungual fibrokeratoma in a 36-year-old male: case report and an update.

Abstract

Acquired digital fibrokeratoma (ADFK) is a rare benign mesenchymal tumor often presenting as a small, firm, hyperkeratotic lesion, typically located in the periungual or subungual regions of the digits. Though benign, ADFK can lead to significant functional or cosmetic issues and may be mistaken for more serious conditions such as squamous cell carcinoma or pyogenic granuloma. We report the case of a 36-year-old male with a 3- to 4‑year history of a progressively enlarging periungual tumor leading to nail deformity and mild pressure effects on the underlying bone. The patient's history included minor trauma, possibly contributing to the lesion's development. Dermatological and histopathological evaluations revealed a well-demarcated mesenchymal lesion with orthohyperkeratosis, irregular acanthosis, and stellate fibroblasts within a vascular stroma, consistent with ADFK. A CT scan confirmed mild deformity of the distal phalanx but no bone infiltration. Surgical excision was offered but deferred by the patient, who preferred monitoring of the lesion. This case highlights the importance of accurate diagnosis through clinical, histopathological, and imaging evaluations to distinguish ADFK from other periungual tumors and underscores the need for individualized treatment based on patient preferences and the lesion's impact.