Photo Quiz

Mass Connected to a Newborn's Finger

 

Am Fam Physician. 2017 Mar 1;95(5):327-328.

A black male infant was born at 40 1/7 weeks estimated gestational age via primary cesarean delivery because of failure to progress. The Apgar score was 9 at one and five minutes. A mass was noted on his right hand.

During the prenatal period, his mother was treated with valacyclovir (Valtrex) for herpes simplex virus infection. Intrauterine ultrasonography showed left kidney pyelectasis. The newborn's older sibling had a similar finding at birth.

Physical examination of the newborn revealed a small, pedunculated mass that was attached by a fine stalk to the ulnar aspect of his right fifth digit (Figure 1). The mass was initially green but turned black at two hours of life. The remainder of the physical examination was unremarkable, with no other cutaneous growths or malformations noted.

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Figure 1


Figure 1

Question

Based on the patient's history and physical examination findings, which one of the following is the most likely diagnosis?

A. Accessory (supernumerary) digit.

B. Acquired digital fibrokeratoma.

Address correspondence to Elizabeth Seiverling, MD, at eseiverling@hmc.psu.edu. Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

REFERENCES

show all references

1. Bolognia J, Jorizzo JL, Schaffer JV, eds Dermatology. Philadelphia, Pa.: Elsevier Saunders, 2012....

2. Elston DM. What is your diagnosis? Supernumerary digit. Cutis. 2006;77(6):360, 365–366.

3. Mannion MA, Fitzgerald B, Filan P. The blue accessory digit. Arch Dis Child Fetal Neonatal Ed. 2016;101(1):F55.

4. Yu D, Morgan RF. Acquired digital fibrokeratoma: a case report. Ann Plast Surg. 2015;74(3):304–305.

5. Elston D, Ferringer T, Peckham S, High WA, DiCaudo DJ, Ko C. Dermatopathology. Philadelphia, Pa.: Elsevier, 2012.

6. Calonje E, McKee PH, eds. McKee's Pathology of the Skin: with Clinical Correlations. 4th ed. Edinburgh, Scotland: Elsevier Saunders; 2012.

7. Failla V, Wauters O, Nikkels-Tassoudji N, Carlier A, André J, Nikkels AF. Congenital infantile digital fibromatosis: a case report and review of the literature. Rare Tumors. 2009;1(2):e47.

8. Devi B, Dash M, Behera B, Puhan MR. Multiple koenen tumors: an uncommon presentation. Indian J Dermatol. 2011;56(6):773–775.

This series is coordinated by John E. Delzell, Jr., MD, MSPH, Assistant Medical Editor.

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