Long-Term Clinicodermoscopic and Histopathological Findings in Onychopapilloma: Outcomes of Surgical Excision and Clinical Monitoring Without Therapeutic Intervention.

BACKGROUND: Onychopapilloma is a benign nail unit tumor with variable clinicodermoscopic features that may mimic malignant nail lesions. Data on clinicodermoscopic-histopathological correlations and long-term outcomes are limited. OBJECTIVE: To characterize clinicodermoscopic and histopathological features, identify factors associated with postoperative recurrence and nail dystrophy, and describe long-term outcomes after surgical excision or clinical monitoring without therapeutic intervention. MATERIALS AND METHODS: The authors retrospectively evaluated 37 patients with onychopapilloma between 2016 and 2025. Fourteen underwent longitudinal excisional biopsy with histopathological confirmation; 23 had compatible clinicodermoscopic findings and were monitored without medical or procedural intervention. RESULTS: The mean age was 55.5 years, and the thumb was the most commonly affected digit (56.7%). Predominant dermoscopic findings were longitudinal erythronychia/leukonychia (62.0%), splinter hemorrhages (59.4%), distal subungual hyperkeratotic mass (54.1%), and distal V-shaped onycholysis (51.4%). Histopathology showed acanthosis (78.6%), hyperkeratosis (71.4%), papillomatosis (50.0%), and parakeratosis (42.9%). Postoperative recurrence occurred in 28.6% of surgically treated patients; recurrent lesions had greater mean transverse width (p < .05). No clinical progression occurred during a mean 4.37-year follow-up in monitored patients. CONCLUSION: Onychopapilloma showed characteristic clinicodermoscopic and histopathological features. In carefully selected patients with typical, stable lesions, structured clinical and dermoscopic monitoring without immediate intervention may be reasonable.