Dear Sir, A 20-year-old man presented with a keratinous lesion covered by a thin nail plate on the radial side of the right thumb (Fig 1). The lesion had been present since birth. The nail plate continued to grow and he simply clipped it occasionally. The base of the lesion was slightly prominent. There was no history of similar abnormalities in his family. X-ray demonstrated a Wassel type II thumb duplication with a miniature radial component at the interphalangeal joint (Fig 2). The nail, nail bed and the radial component were excised and the radial collateral ligament reconstructed. Histological examination of the specimen confirmed the diagnosis of an ectopic nail. At follow-up there was a stable IP joint. The patient was satisfied with the alignment and appearance. The range of motion at the IP joint was 0-60deg.
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