Accessory nail of the right index finger following trauma

A 35-year-old man presented with a hard, curved, nail-like projection arising adjacent to the right ring-finger nail for 1 year.e lesion was asymptomatic.He reported a history of trauma to the same finger 2 years earlier.Examination revealed a separate, well-defined, translucent keratin plate distal to the proximal nail fold, distinct from the main nail Figure 1.Dermoscopy was performed using contact polarized (10x) mode with a liquid interface, which demonstrated parallel longitudinal striations with a smooth, shiny surface, and absence of vascular or hemorrhagic structures, consistent with an accessory (ectopic) nail Figure 2.e patient was counseled regarding the benign nature of the lesion.Surgical excision was advised; however, he opted for conservative management as the lesion was asymptomatic.Ectopic nail (onychoheterotopia) is a rare entity, with fewer than 100 cases reported in the literature. 1It may be congenital or acquired following traumatic implantation of nail matrix cells.Surgical excision of the ectopic matrix is the definitive treatment. 2Recognition of this benign condition prevents misdiagnosis as onychomatricoma or cutaneous horn.