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A 59-year-old woman presents with a tender bump on her right middle finger. She reports a history of arthritis. The lesion is relatively asymptomatic, except for mild tenderness to palpation. On physical examination, between the proximal nail fold and the distal interphalangeal joint, a solitary, flesh-colored, semi-translucent lesion is observed. A small dark area is noted at the apex of the lesion.
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This patient was diagnosed with a digital myxoid cyst, the most common ungual tumor after warts. It has a female predominance and occurs most commonly in patients aged between 40 years and 70 years.
In those individuals younger than age 30 years, trauma is often the precipitating factor in formation of the cyst.1 The etiology of myxoid cysts is unclear but is thought to involve mucoid degeneration of connective tissue. It may be seen in association with both osteoarthritis and rheumatoid arthritis.2
Digital myxoid cysts can be recognized through clinical presentation. They arise on the dorsum of the hand as a translucent nodule located between the distal interphalangeal joint and the proximal nail fold.2 They tend to occur more frequently on the dominant hand, specifically on the middle and first fingers.1,3,4 These cysts are typically asymptomatic, but patients may experience pain, tenderness, and decreased range of motion or have nail deformities.1
When required, a definitive diagnosis of a myxoid cyst can be obtained through biopsy or magnetic resonance imaging (MRI) of the lesion. MRI can distinguish myxoid cysts from other bony tumors, such as ganglion cysts.
Asymptomatic digital myxoid cysts do not require therapy; smaller lesions may respond to daily compression over the course of several weeks.1,5 Some lesions spontaneously regress. If the patient is symptomatic, surgical excision with debridement of joint osteophytes may be curative but can eventuate in nail deformity when in proximity to the nail.1 This patient was treated with incision and drainage of the lesion, followed by daily compression, which resulted in complete resolution.
Megha D. Patel is a student at the Commonwealth Medical College, Scranton, Pennsylvania.
Stephen Schleicher, MD, is an associate professor of medicine at the Commonwealth Medical College and an adjunct assistant professor of dermatology at the University of Pennsylvania Medical College. He practices dermatology in Hazleton, Pennsylvania.
References
- Li K, Barankin B. Digital mucous cysts. J Cutan Med Surg. 2010;14(5):199-206.
- Salerni G, Alonso C. Images in clinical medicine. Digital mucous cyst. N Engl J Med. 2012;366(14):1335.
- Mani-Sundaram D. Surgical correction of mucous cysts of the nail unit. Dermatol Surg. 2001;27(3):267-268.
- Kasdan ML, Stallings SP, Leis VM, Wolens D. Outcome of surgically treated mucous cysts of the hand. J Hand Surg Am. 1994;19(3):504-507.
- Wolff K, Johnson RA, eds. Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology. 6th ed. New York: McGraw-Hill Education; 2009.
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