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Skin lesion opinion wanted

Discussion in 'General Issues and Discussion Forum' started by dsfeet, Oct 17, 2013.

  1. dsfeet

    dsfeet Active Member


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    60 year old male presents with this lesion see attached photos. Been present for approx 12 months. Is painful if steps on something or in bare feet. The area is pink, soft and raised. There is no signs of verrucae just callusing and fissuring around the lesion but generally the feet are callused and fissured and poorly looked after. I feel it was a cyst and have referred him for a 2nd opinion to a dermatologist but the wait for this opinion is long. Meantime anyone got any suggestions.
     

    Attached Files:

  2. Paul Bowles

    Paul Bowles Well-Known Member

    Pyogenic granuloma?
     
  3. Ian Drakard

    Ian Drakard Active Member

  4. drsarbes

    drsarbes Well-Known Member

    DD:
    Dermatofibroma
    Cicatrix - foreign body reaction
    Granuloma
    WTHK

    Steve

    ps

    WTHK=who the hell knows.
     
  5. dsfeet

    dsfeet Active Member

    thanks paul and Ian

    Ian
    your pic is exactly what my patients lesion looked like, even same size...dermatofibroma, thanks..... , Ian , what was your patients outcome, did it require surgery, ?? and other tx regime?
    dsfeet
     
  6. Ian Drakard

    Ian Drakard Active Member

    I think surgery was the only long term option. I gave advice on padding and offloading as management then referred on for biopsy and excision. Unfortunately never heard back so can't cofirm dermatofibroma/dermoid cyst or not :boohoo:

    Hope you manage to follow this one- let us know :drinks
     
  7. dsfeet

    dsfeet Active Member

    thanks Ian
    will do......ladies lady friend is long term patient so I should hear...however does depend on whether Dr refs him and whether He follows through with referral. He was convinced it was a verrucae and although I did tell him it was definitely Not I am not sure he 100% believed me.
     
  8. davsur08

    davsur08 Active Member

    Squeeze the lesion, a dermato fibroma will form a dimple in the middle of the lesion, " the dimple sign" is pathoneumonic for dermatofibroma.
     
  9. dsfeet

    dsfeet Active Member

    great tip , don't see him for 10 weeks ...a EPC patient
    thanks
     
  10. blinda

    blinda MVP

    Lovin' Rome.

    Looks like PG to me. Gotta rule out amelanotic MM tho.
     
  11. Podess

    Podess Active Member

    DSfeet,
    Thank you for posting this interesting picture.

    IMO I would rule out pyogenic granuloma as these usually develop at sites of trauma and no history of trauma has been mentioned. In addition they usually show vessels of varying sizes under the epidermis.

    Dermatofibroma are usually 3-7mm across and have some degree of pigmentation at the outer rim.

    Could be acrochordon, which flatten in weight-bearing areas or just a bog-standard cyst.

    Please keep us posted as to the outcome

    Podess
     
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