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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.

 

Pyogenic granuloma?

 

Reminds me of this one I saw:

http://www.podiatry-arena.com/podiatry-forum/showthread.php?t=67113

Sadly never heard back on biopsy for this one

 

DD:
Dermatofibroma
Cicatrix - foreign body reaction
Granuloma
WTHK

Steve

ps

WTHK=who the hell knows.

 

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

 

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

 

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.

 

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

 

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

 

Lovin' Rome.

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

 

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