Unusual lesion - help and advice sought!

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Hi there,

I am wondering if anyone can give me any advice on a very unusual lesion. My patient is a 45 year old very active lady who came to me 9 months ago with what looked like a neurovascular corn on the left 4th MPJ. After it was treated and given padding etc she returned a month later saying it felt loads better after it had been done but was starting to get very sore again. Since then the lesion has rapidly changed in appearance and the pain has increased so much that pt can barely walk. Like i said, it started off having the appearance of a neurovascular corn but now it is larger, has a very macerated centre and fibrous edges with black lines (not capillaries) running through it. At first i could achieve some very deep debridement but now i can barely touch it with a scalpel because of the pain which the pt says goes up to the tips of her toes and down to her heel. I sent skin scrapings to Virology to check for HPV at request of consultant who thought it might be a verruca but they dont do the test. I have given her every kind of padding under the sun and it makes no difference.
Last week the pt had an MRI scan of her foot and she said that the pain in the lesion when she was having the MRI was the worst pain she had ever experienced - like a hot sharp knife going right into the lesion. She has also been to dermatology who told her it was just a corn.

So.......any advice or thought etc would be greatly appreciated as i am just at a loss as to what to do next for her. She is seeing the consultant again next week for the results of her MRI.
Incidentally, and it might not be related, the patient was on holiday in Vietnam and became extremely unwell when she came home - hospitalised for 2 weeks with what the docs described as something viral (ie, they didnt know what caused it) and its since then the lesion has rapidly become much worse.......possibly related??

Many thanks in advance for any help
D

 

Hi Dolag,

:welcome: to the Arena! Don`t suppose you have a pic of the lesion? Always handy when seeking a derm opinion. I don`t like any lesion with `black lines`so you were wise to send for further investigation. Did either the virology or dermatology departments take a biopsy?

Any other med history? Pain and burning sensation can be associated with herpes zoster. Only other viral condition I can think of is hand-foot-and-mouth disease.

Keep us posted on the outcome.

Cheers,
Bel