Toe nodule obliterating the nail bed.

260 CUTIS WWW.CUTIS.COM PLEASE TURN TO PAGE 281 FOR PHOTO CHALLENGE DISCUSSION A generally healthy 30-year-old man presented with a 3-cm exophytic, yellowish red, subungual nodule of the left great toe of 1 year’s duration that was obliterating the nail plate. Ten years prior, a similar nodule in the same location was removed via laser by a podiatrist. Medical records were not retrievable, but the patient reported that he was told the excised lesion was a benign tumor. Plain radiographs were performed at the current presentation and demonstrated an inferior cortical lucency of the distal phalanx as well as a lucency over the nail bed region with extension of calcification to the soft tissues. Magnetic resonance imaging showed a mass with a proximal to distal maximum dimension of 2.1 cm that involved the dorsal surface of the proximal phalanx. Magnetic resonance imaging also demonstrated bone erosion from the overlying mass. A 4-mm incisional punch biopsy was performed prior to surgical excision.