Subungual and Periungual Fibrolipomas Presenting with Nail Dystrophy: A Case Report

Subungual tumors are rare and often misdiagnosed, leading to unnecessary procedures or delayed treatment; thus, accurate identification of benign neoplasms such as fibrolipoma is essential to guide appropriate management. We report a 59-year-old man who presented with a several-year history of a painless subungual mass of the right great toe with progressive nail thinning and onychodystrophy. Imaging demonstrated soft-tissue swelling without bone involvement. Surgical exploration revealed two well-demarcated, lobulated subungual and periungual masses that were completely excised. Histopathology showed mature adipocytes with fibrous septa, and fluorescence in situ hybridization confirmed HMGA2 translocation without MDM2 or CDK4 amplification, establishing the diagnosis of fibrolipoma. Complete excision resulted in satisfactory nail regrowth at 1-year follow-up with no recurrence. This case highlights the importance of including fibrolipoma in the differential diagnosis of subungual masses and supports the value of histopathological and molecular analysis in achieving precise diagnosis and optimal surgical outcomes.