Unusual 5th toe lesion help please

Members do not see these Ads. Sign Up.

Hi Folks
I wonder if anyone can give suggestions with this lesion.
Pt is 39 y/o female office worker no health issues or meds.
A year ago she did an unexpected lengthy walk on holiday . Sock rucked under her foot and developed a blister under 5th toe. Dressed with blister plaster.Presents with this purple/black lesion.
The toe tucks well under 4th toe . Appeared to be typical "ice skate" shaped callus ( my term) rolleyes: often seen on the plantar edges of lesser toes of many people .I am sure we all see them regularly.
The edge appeared thin and sharp and I pared what I thought was callus with dried blood blister remains within it. However it began bleeding instantly.The blood was normal colour not dark etc. On closer examination using 10x magnifier lamp from eschenbach the skin appears quite normal other than the colour,there is no unusual pigmentation .The lesion has been there for almost 12 months approx .without improvement nor worsening . The shape medially 4/5 web becomes smoothly pointed ,like a speech bubble on cartoons but of smooth edges.
My photo's are as good a resolution as I could get.I am not sure how to do macro shots.
Does not seem particularly sinister to me.But 20 years and counting I have not seen this before. The rougher centre area is my doing.
Any ideas folks?
I made the silicon splint to lift the toe up to improve the amount of ground contact surface .I have referred on to GP
All donations gratefully received

 

Hi Geoff,

The dark area is almost certainly dried blood/serum/silver nitrate remnant? Can I see a verruca (lower centre 001)? Maybe further lesions medially?

 

Thanks John
When using my eschenbach 10 x magnifier ,which with my face almost touching the lens really shows the skin exceptionally well .I saw nothing that would suggest vp. I considered them when attempting to debride the area.
Regards
Geoff

 

Me if I saw something like that I would think - better refer to get a Biopsy done - Maybe it is the Australian in me - black lesion think skin Cancer 1st especially if the lesion bleed like you said.

 

Hi Mike
That is why I referred pt on to her GP
Thanks

 

we received a poster in the podiatry now magazine about 2 months ago, which showed something almost identical as a malignant melanoma. Got to be worth considering

 

Thank you for those giving previous advice.
update is the lady went to GP and referred on for biopsy which showed melanoma
then plastic surgery for removal diagnosis confirmed.Further surgery may be yet required i.e. toe amp.
The lady has expressed thanks for input given .

 

Thanks for update on this. Think I missed this thread back in January but great reminder to stop and think sometimes.

 

Obviously this is now diagnosed and being resolved, but is absolutely melanoma. I had a patient develop one recently at a prominent 2nd met head. Once you have seen one clinically you will never miss it again. The lesion in my case deteriorated from a mole that had gone unchanged in 85 years to an ulcerated melanoma within 2 months. This got me researching trauma and melanoma and development of a melanoma from a seemingly safe skin pigmentation is relatively common, especially on the soles of the feet where trauma is so easy. Mixed reviews with studies as to whether trauma does in fact deteriorate a lesion to a melanoma, most contradiction owing to the fact that the hands and feet are subjected to a lot of sun, and are also subjected to a lot of trauma.

Considering the traumatic onset of your patients lesion, Geoff, does make one think

 

In view of the increased incidence of MM, I would recommend that all read this excellent article;

Clinical guidelines for the recognition of melanoma of the foot and nail unit