Derm Dx: Growth on the Second Toe - Clinical Advisor

Derm Dx: Growth on the Second Toe

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A 48-year-old man presents with a growth on the dorsomedial aspect of his left second toe which overlies the second distal interphalangeal joint. The lesion has been present for several months. It was drained and deroofed by his podiatrist but recurred. Examination reveals a translucent, tense, dome-shaped papule with superficial telangiectasia.

Can you diagnose this condition?

Myxoid cysts (also known as synovial cysts, mucinous pseudocysts, and periungual ganglia) are benign intradermal lesions often associated with osteoarthritis of the digits of the hands and feet.1 These lesions usually have a pedicle connecting the primary lesion directly to...

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Myxoid cysts (also known as synovial cysts, mucinous pseudocysts, and periungual ganglia) are benign intradermal lesions often associated with osteoarthritis of the digits of the hands and feet.1 These lesions usually have a pedicle connecting the primary lesion directly to the underlying joint.2 They occur most commonly on the dorsal aspect of the digit between the distal interphalangeal joint and the cuticle. A typical presentation is of a dome-shaped, translucent papule or nodule in the area of the proximal nail fold. Mucoid “jelly-like” hyaluronate gel is expressed when punctured or debrided.3

Treatment modalities include surgical removal, drainage, sclerotherapy, cryotherapy, and corticosteroid injection. Surgical management has been shown to have the highest cure rates.4 Myxoid cysts are more challenging to treat successfully on the foot due to increased joint pressure as a result of weight bearing. Treatments that specifically address the open communication with the joint have the highest degree of success.5

Nelson Maniscalco, DPM, is a podiatric-dermatology fellow under the aegis of St. Luke’s Medical Center and the DermDox Centers for Dermatology, and Stephen Schleicher, MD, is director of the DermDox Center for Dermatology, as well as an associate professor of medicine at Commonwealth Medical College and a clinical instructor of dermatology at Arcadia University and Kings College.

References

  1. Goecker RM.  Chapter 46: Digital Mucoid Cysts. In: Podiatry Institute Update. http://www.podiatryinstitute.com/pdfs/Update_2004/2004_46.pdf. Published 2004. Accessed July 22, 2019
  2. Kim EJ, Huh JW, Park HJ. Digital mucous cyst: a clinical-surgical study. Ann Dermatol. 2017;29(1):69-73.
  3. Park JH, Lee DY, Kim N. Nail neoplasms. J Dermatol. 2017;44(3):279-287.
  4. Jabbour S, Kechichian E, Haber R, Tomb R, Nasr M.  Management of digital mucous cysts: a systematic review and treatment algorithm. Int J Dermatol. 2017;56(7):701-708.
  5. de Berker D, Lawrence C. Ganglion of the distal interphalangeal joint (myxoid cyst): therapy by identification and repair of the leak of joint fluid. Arch Dermatol. 2001;137(5):607-610.
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