Is it a VP?

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I have seen a middle aged man with a strange looking circular verruca on the plantar surface. It was 1 cm in diameter, smooth with no 'black spots' and a pinkish colour, almost transparent. There was a surrounding area of thickened skin with the 'fingerprint' lines going round the VP. He said the area feels numb.
Do you think he has a VP?
I have used 60% salicylic acid dressing to be left on it for 7 days. He has not come back yet

 

Can you please post an image and give the hxpc, fhx, social hx, pmhx and examination please?

Many thanks

Bill Liggins

 

Zsusanna

Do you think it a wise move to treat with 60% sal acid on a lesion which you are not sure about.

There is no way on earth anyone on this forum could give you a diagnosis without a better clinical presentation and a picture.

I believe, and am happy to be corrected, that most of the litigation against pods is for VP treatments that have gone wrong. Yours sounds like another one waiting to happen.


CM
CM

 

Conmerchant,

Although I do not officially represent SCP when I say this, I have heard from an expert witness and someone VERY HIGH UP within SCP, that orthotics and VPs head the litigation tables.

People are not being informed of the pain/breakdown that treatments such as acids or cryo involve. Patients are not being given info leaflets about it, let alone being asked to sign a piece of paper acknowledgeing that it may be very painful.

I agree with you, if you do not have a diagnosis, you can't treat safely or effectively.

Also even for VPs, written consent involves much more that just "I consent to having this git frozen."

You MUST give the pros and cons of treatment, and MUST state what alternative treatments are available, together with their pros and cons. You should also state what the success rate of each treatment modality is.

If you do not do the above, effective consent is invalid and you have technically assaulted that patient.

If you do not believe me, ask your professional body!

Also, how many pods just go on and on treating VPs without reviewing the treatment?

I have collegues who gave up on trichlo/monochlor/pyrogal acid ages ago. They are just too painful/unpredictable!

 

Zsuzsanna,

And do you think we are all clairvoyants? Without a picture no-one can tell - and maybe not even then.

Are you completely nuts?

Why in the name of sweet reason are you putting a strong macerating agent on an unknown lesion? :bang:

Probably because he's busy at his solicitors filing a damages claim against you.

regards etc

Catfoot

 

Thank you for your concerns. I am calling him back and will remove the dressing straight away!
I don't know what possessed me to put it on.

 

Zsuzsana,

and neither, I suspect, does anyone else.

However, I am relieved to hear that you are acting speedily to effect some damage limitation.

May I very respectfully suggest if, after 10 years in practice, you are still having problems identifying VPs that you either :-

a) refer on to someone who can
b) go back to SMAE and do an update course on VPs, or
c) both

yours etc

Catfoot

 

I have pared the dead skin, it seemed to be a VP. The patient said that it felt much better.
I am going to try and post a photo.

 

I have removed the 60% salicylic acid and pared the verruca. I am sure that's what it is now. The patient is happy and says that the area feels a lot better.

I have not posted a picture on this site before so I'll have a go now.
I am afraid the medication spread a little.

 

Zsuzsanna,

OMG

I'm speechless.

Catfoot

 

Nothing like a punch in the face to sober up..... (me, not you, Zsuzsanna) You really need to take note of the candid guidance offered on this thread. You should not be attempting to treat ANYTHING that you are unsure of what the diagnosis is. I did offer you advice in another thread; white lines http://www.podiatry-arena.com/podiatry-forum/showthread.php?t=64311 (better still http://www.youtube.com/watch?v=2ChjLMbXVrU) Medical History is paramount to any diagnosis and APPROPRIATE treatment.

Let`s hope you acheived damage limitation on this occasion.

Bel

 

This the photo of the foot. I must say that I have not seen a similar VP before. Have you?

 

I suggest that you monitor this very, very carefully. Not just the original lesion (which, IMO, looks more like a dermatofibroma. Difficult to say with the tissue damage) but also the extensive tissue breakdown caused by the spread of Sal Acid.

I would also suggest that you refer the pt on to a practitioner who can obtain a definitive diagnosis, preferably by biopsy, and formulate an appropriate treatment plan. Let`s hope it`s not a nodular basal cell carcinoma.....

Bel

 

I also feel that this looks like some sort of fibroma but could also be an epidermoid cyst, a histiocytoma, or if there was initially a reddish spot, a sclerosing haemagnioma.

Bel's advice is good - it needs a biposy to rule out - amongst other things - an unlikely amelanotic melanoma.

All the best

Bill Liggins

 

zsuszanna, congrats on the photo, nice one! Also congrats on asking about this lesion. I have no doubt that you along with many others will think there treatment scenarios through a little more in some circumstances. Perhaps a good lesson learnt. (You stood up to the education well ))

Cheers

 

Dear All,

during my recent four years in Sydney i came across a chap with a peculiar lesion on his foot.

I considered the Mole to be suspicious due to it not looking right. nothing definite but a suspicion that all was not well. Asked a colleague to have a look and they agreed with me that it seemed to be a mole going wrong.

In aus any mole on the foot lower limb is a primary target for malignancy, so we both advised straight to Dermatologist for excision biopsy.

So off he tottered.

We had a phone call a few days later from a very pleased patient. the mole was not malignant, but was still suspicious.

BUT:butcher: The dermatologist being a good sort said DROP EM. So pt was subjected to a whole body examination and on his back were two malignant melanoma's. So he had to have quite significant surgical excision of the two melanoma's with skin grafts.

So i am glad i was suspicious and referred on, and i am glad i was wrong but the potential is now marked for follow up.

I am extremely glad the dermatologist took my referral seriously and did a whole body examination.

If you do not know. Say so and say i know a man who might.:drinks

So if you do not know and the photos in your clinical ref books are not really much help and your colleague also is not able to make a definitive diagnosis.

Then for Pity's sake refer.

To embark on a t/t on a lesion you do not know what it is is UTTER MADNESS and your friendly Dermatologist will no longer be your friend and neither will the pt or his lawyer.

It is not negligent to NOT Know:deadhorse:

It is to embark on a treatment that will cause further damage to the lesion and not get a Confirmed clinical diagnosis from another agent.

Dermatologist love relevant referrals from concerned colleagues. They even return the compliment by advising they're pts to see you for a Podiatry problem .

regards David

 

True dat.

 

I would tend to agree with the fact that all or any of the above are possible. It looks in no way constitent with a VP.

Speaking of amelanotic melanoma, I had a patient with a fairly painless lesion on the dorsal surface of the (R) foot.

Referral to dermatologist confirmed an amelanotic melanoma. A very sneaky looking lesion. Not at all remarkable , but we all know the potential. Ahhhh the wonderful Aussie sun and its benefits.


C

 

Catfoot, You make me laugh...You have a wonderful economy with words.. Have you thought of doing stand up comedy?? . Keep up the good work .

C

 

Footdrcb I agree. since I've been in Australia I have seen many suspicious lesions on the feet and always send for Dermatologist assessment or biopsy. Would rather be wrong then leave it.
Unfortunately, all too often it is melanoma (benign or malig) and if it isn't the patient (and Specialist / Dr) is happy you've got it checked.
The Sun, great for laundry not for skin

 

footdrcb,
Thank you for your kind words, I'm glad I have amused you. Why use 10 words when three will do? That's what I say!

"Brevity is the soul of wit" Polonius
Hamlet. Act 2 Scene 2 86-92.

To return to VP, I have a booking next week from a new patient who has "something funny" on their foot. The GP has treated it as a VP with no success. That should be interesting.

regards

Catfoot

 

Indeed. Won`t you please post it as a case study here? I think it would be beneficial for quite a few.

Cheers,
Bel

 

Hi Blinda,
If the patient's mum gives permission (the pt is 16) then I'll see if I can post a photo.
regards

Catfoot

 

Blinda et al,
Re post 22# on this thread:-

Sorry to disappoint you guys but I saw the lesion today and it is a tiny VP, tiny, but still a bogstandard VP.

regards

Catfoot

 

Thank you for the advice. I shall refer the patient for further tests.
Is it possible to get an amelanotic melanoma on the sole of the foot?

 

Glad to hear that.

An amelanotic melanoma is a melanoma lacking pigment and occurs in the epidermis. So, yes, if there is epidermis on the plantar aspect of the foot.................

 

Zsusanna

"Is it possible to get an amelanotic melanoma on the sole of the foot?"

I cannot believe you even asked that question.

It may be time for you to undertake some serious dermatology CPD.

CM

 

:bash:

 

Are you aching for the blade ?
That's ok, Were insured
We`re getting away with it all......

http://www.youtube.com/watch?v=06FDqNM6Pec&feature=related

Everyone, (not just Zsuzanna) Please, please refer on anything that you are unsure of. Don`t just `have a go`, without a definitive diagnosis.

 

Blinda,
It is a sad indictment of our profession when you have to post a warning like that.

Not only is it embarrassing, it could explain why we are not taken seriously by other AHPs.

Zsuzsanna, will you please wake up and smell what you're shovelling ?

regards

Catfoot

 

Can`t disagree with you there, Catfoot.

It is every practitioners responsibility to ensure that they are delivering safe, evidenced based treatment, which includes acknowledging the limit of their scope of practice and being prepared to refer on.

With regard to how other Allied Health Professions perceive us, there are an equal amount of `good and bad` practitioners in all Professions. Again, it is up to the individual practitioner to create appropriate professional relationships, i.e. referral pathways, and demonstrate our capabilities.

Cheers,
Bel

 

And, on a lighter note

http://www.heraldsun.com.au/news/br...lso-loses-finger/story-e6frf7jx-1226076596044

Shame really. If it had been a genital wart he'd have made a darwin award for sure!

 

I thought that this was a website where podiatrists and chiropodists can talk to each other, discuss things and learn from each other's experience.
I must say you stamped very heavily on me for daring to ask a question which sort of discourages me for sharing any of my concerns with you on the future.
I have taken your point and I know very well to refer someone to a higher authority if I am in doubt, so in future I will just do that and not ask on this site.

 

Hi zsuzsanna,

You are correct. This is indeed a website dedicated to sharing information, gaining knowledge by asking questions about a plethora of podiatric anomalies.

I believe our colleagues were reacting not to your question but to your treatment of a lesion without firstly appropriately diagnosing it first.

Although you may interpret their responses as harsh. Consider it a lesson well learned in that future questions should occur prior to any treatment being administered. This feedback is for the benefit of future practice.

Never be afraid to ask a question, it is how we increase our knowledge through the experience gained by others. It is guessing that is dangerous.

A really good thread which you may find useful: Presenting patients for clinical advice.

Kind regards,

Mandy.

 

Szuzsanna,
No one stamped on you for asking a question.

You were "stamped on" for acting recklessly, thoughlessly and with a disregard for your patients's well-being that bordered on stupidity. IMO the lack of insight you have demonstrated here shows you are not safe to practice.

Perhaps you would like to put the question you asked and the information you gave here to the tutors from your training organisation? I would suspect you would receive the same response. This in itself begs the question as to why you have not approached your own organisation, as I undertand they have a facility to enable members to seek advice?

regards

Catfoot