Comparison of Subungual Glomus Tumours in Terms of Nail Aesthetics and Recurrence According to Size and Location in the Germinal or Sterile Matrix

Abstract

Purpose The aim of this retrospective study was to investigate the effect of subungual glomus tumour size and localization in the germinal or sterile matrix on tumour recurrence and aesthetic outcomes.

Patients and Methods From 35 patients who underwent surgery for a subungual glomus tumour between February 2013 and February 2020, 26 patients – 17 women and 9 men – with 27 subungual glomus tumours fulfilled the inclusion criteria. The average age was 37.3 (22–58) years. According to the patients’ surgical notes and preoperative magnetic resonance images 14 tumours were located in the sterile, 13 in the germinal matrix, and the mean size of the glomus tumours located in the germinal matrix was 4.9±1.7 mm, in the sterile matrix 3.6±1.0 mm. At the postoperative 12th month follow-up visit nail aesthetic was evaluated objectively according to Zook’s fingernail appearance scoring. In addition, patients were asked to evaluate the pain and nail appearance in the involved finger by VAS (Visual Analog Scale 0–10). Patients who experienced recurrence were noted.

Results No significant Zook’s fingernail appearance score differences were observed between germinal and sterile matrix groups (p=0.097). Comparison of VAS score for pain and VAS score for nail appearance between the two groups also yielded similar values (p=0.449 and 0.395, respectively). The recurrence rate was similar at both locations (p=0.557) with 3 recurrences in the germinal, and 2 in the sterile matrix group. There was no relation between tumour size, Zook’s fingernail appearance score (p=0.874) and recurrence (p=0.784). The observed germinal matrix glomus tumours were significantly larger than the sterile matrix tumours (p=0.031).

Conclusion Neither subungual glomus tumour size nor localization in the germinal or sterile matrices has different effects on nail appearance and recurrence.

Zusammenfassung

Ziel Diese retrospektive Studie untersucht, ob die Größe und Lokalisation subungualer Glomustumoren in der germinalen oder sterilen Matrix Einfluss auf das postoperative Erscheinungsbild der Fingernägel und die Rezidivrate haben.

Patienten und Methoden Von 35 Patienten, bei denen zwischen Februar 2013 und Februar 2020 ein subungualer Glomustumor entfernt wurde, erfüllten 26–17 Frauen und 9 Männer – mit 27 subungualen Glomustumoren die Einschlusskriterien. Das Durchschnittsalter betrug 37,3 (22–58) Jahre. Die Auswertung der Patientenakten und der präoperativen Kernspinuntersuchungen ergab, dass 14 Tumoren in der sterilen und 13 in der germinalen Matrix lokalisiert waren sowie dass die durchschnittliche Größe der Glomustumoren der germinalen Matrix 4,9±1,7 mm und die der sterilen Matrix 3,6±1,0 mm betrug. Bei der Nachuntersuchung nach 12 Monaten wurde das Erscheinungsbild und die Qualität des Fingernagels der betroffenen Finger objektiv mittels des Fingernail Appearance Score von Zook beurteilt. Zusätzlich bewerteten die Patienten das Erscheinungsbild des Fingernagels als auch vorhandene Schmerzen mittels der visuellen Analogskala (VAS 0–10). Weiterhin wurde die Rezidivrate erfasst.

Ergebnisse Zooks Fingernail Appearance Score ergab keinen signifikanten Unterschied zwischen Glomustumoren der germinalen und sterilen Matrix (p=0,097). Auch bzgl. vorhandener Schmerzen und der subjektiven Beurteilung des Erscheinungsbildes der Fingernägel durch die Patienten anhand der VAS ergaben sich keine signifikanten Unterschiede zwischen den beiden Gruppen (p=0,449 und 0,395). Ebenso ergab sich bzgl. der Rezidivrate kein signifikanter Unterschied zwischen den Gruppen (p=0,557) bei 3 Rezidiven nach Tumoren der germinalen und 2 der sterilen Matrix. Die Tumorgröße hatte weder auf Zooks Fingernail Appearance Score (p=0,874) noch auf die Rezidivrate (p=0,784) Einfluss. Glomustumoren der germinalen waren signifikant größer als Glomustumoren der sterilen Matrix (p=0,031).

Schlussfolgerung Weder die Größe subungualer Glomustumoren noch deren Lokalisation in der germinalen oder sterilen Matrix haben Einfluss auf das postoperative Erscheinungsbild und die Qualität des Fingernagels und die Rezidivrate.

Keywords

Subungual glomus tumour - germinal matrix - sterile matrix - recurrence rate - fingernail appearance

Schlüsselwörter

Subungualer Glomustumor - germinale Matrix - sterile Matrix - Rezidivrate - Aussehen des Fingernagels

Publication History

Received: 24 October 2021

Accepted: 28 January 2022

Article published online:
07 September 2022

• References

• 1 Vasisht B, Watson HK, Joseph E. et al. Digital glomus tumors: a 29-year experience with a lateral subperiosteal approach. Plast Reconstr Surg 2004; 114: 1486-1489
• 2 Tomak Y, Akcay I, Dabak N. et al. Subungual glomus tumours of the hand: diagnosis and treatment of 14 cases. Scand J Plast Reconstr Surg Hand Surg 2003; 37: 121-124
• 3 Trehan SK, Athanasian EA, DiCarlo EF. et al. Characteristics of glomus tumors in the hand not diagnosed on magnetic resonance imaging. J Hand Surg Am 2015; 40: 542-545
• 4 Chou T, Pan SC, Shieh SJ. et al. Glomus Tumor: Twenty-Year Experience and Literature Review. Ann Plast Surg 2016; 76: 35-40
• 5 Lee IJ, Park DH, Park MC. et al. Subungual glomus tumours of the hand: diagnosis and outcome of the transungual approach. J Hand Surg Eur 2009; 34: 685-688
• 6 Morey VM, Garg B, Kotwal PP. Glomus tumours of the hand: Review of literature. J Clin Orthop Trauma 2016; 7: 286-291
• 7 Lin YC, Hsiao PF, Wu YH. et al. Recurrent digital glomus tumor: analysis of 75 cases. Dermatol Surg 2010; 36: 1396-1400
• 8 Abimelec P, Dumontier C. Basic and advanced nail surgery. (Part 2: indications and complications). In: Scher RK, Daniel III CR, eds. In: Nails: Diagnosis, Therapy, Surgery 3 rd ed.. Philadelphia: Elsevier/Saunders; 2005. 294.
• 9 Samaniego E, Crespo A, Sanz A. Key diagnostic features and treatment of subungual glomus tumor. Actas Dermosifiliogr 2009; 100: 875-882
• 10 Roan TL, Chen CK, Horng SY. et al. Surgical technique innovation for the excision of subungual glomus tumors. Dermatol Surg 2011; 37: 259-262
• 11 Fong ST, Lam YL, So YC. A modified periungual approach for treatment of subungual glomus tumour. Hand Surg 2007; 12: 217-221
• 12 Zook EG. Anatomy and physiology of the perionychium. Hand Clin 2002; 18: 553-559
• 13 Bhaskaranand K, Navadgi BC. Glomus tumour of the hand. J Hand Surg Br 2002; 27: 229-231
• 14 Zook EG, Guy RJ, Russell RC. A study of nail bed injuries: causes, treatment, and prognosis. J Hand Surg Am 1984; 9: 247-252
• 15 Kaliyadan F, Ashique KT. Nail Photography: Tips and Tricks. J Cutan Aesthet Surg 2016; 9: 254-257
• 16 Netscher DT, Aburto J, Koepplinger M. Subungual glomus tumor. J Hand Surg Am 2012; 37: 821-823
• 17 Madhar M, Bouslous J, Saidi H. et al. Which approach is best for subungual glomus tumors? Transungual with microsurgical dissection of the nail bed or periungual?. Chir Main 2015; 34: 39-43
• 18 Altinel D, Serin M, Leblebici C. et al. Transungual resection of subungual glomus tumour. BMJ Case Rep 2017; bcr2017221211
• 19 Çevik HB, Çiçek ÇA, Kayahan S. et al. Glomus tumors of the upper extremity. Handchir Mikrochir Plast Chir 2021; 53: 72-75
• 20 Gandon F, Legaillard P, Brueton R. et al. Forty-eight glomus tumours of the hand. Retrospective study and four-year follow-up. Ann Chir Main Memb Super 1992; 11: 401-405
• 21 Asmar G, Mati T, Pop IA. et al. The ‘shark mouth’ flap approach for digital glomus tumours in 24 patients: technique and clinical outcomes. J Hand Surg Eur Vol 2020; 45: 153-159
• 22 Lee SH, Roh MR, Chung KY. Subungual glomus tumors: surgical approach and outcome based on tumor location. Dermatol Surg 2013; 39: 1017-1022
• 23 Gandhi J, Yang SS, Hurd J. The anatomic location of digital glomus tumor recurrences. J Hand Surg Am 2010; 35: 986-989
• 24 Patel L. Management of simple nail bed lacerations and subungual hematomas in the emergency department. Pediatr Emerg Care 2014; 30: 742-745
• 25 Civan O, Güntürk ÖB, Özaksar K. et al. Glomus tumors of the nail bed: topographic anatomy and an algorithmic approach based on the topography. Handchir Mikrochir Plast Chir 2020; 52: 202-206
• 26 Drapé JL, Idy-Peretti I, Goettmann S. et al. Subungual glomus tumors: evaluation with MR imaging. Radiology 1995; 195: 507-515