Which approach is best for subungual glomus tumors? Transungual with microsurgical dissection of the nail bed or periungual?

Glomus tumors are rare, accounting for 1% to 5% of all hand tumors. The treatment of subungual glomus tumors consists of complete surgical excision, either by the periungual or transungual approach. Tumor recurrence and nail dystrophy are the main complications. The purpose of this study was to evaluate the outcome as a function of the surgical approach used - transungual or periungual. Fifty-three patients presenting with a subungual glomus tumor underwent surgical excision through the periungual approach if the tumor was peripheral, or the transungual approach if the tumor was centrally located. These patients were followed for an average of 2years. Pain relief was always obtained the day following surgery. Wound healing was achieved on average after 2weeks with the periungual approach and 5weeks with the transungual approach. Other than some longitudinal striations in 10 patients (18.9%) who had been operated through the transungual approach, there were no complications or tumor recurrence. We recommend a periungual approach for a peripheral tumor and a transungual approach for a central tumor. The latter approach, which carries some risks of nail-related sequelae--always minor in our experience--allows for better exposure if the tumor is centrally located.