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This has had a biopsy and come back as a verrucae, but it is no verrucae I have ever seen. The black edge is from a previous application of silver nitrate. What's your opinion?

 

I am no skins person, but that look nasty - really nasty. What did the swabs say? My gut reaction is a flesh eating bug. Rob

 

I haven't read the report first hand but the patient said it was a verrucae, but we are sending her back to her GP for a 3mm punch biopsy in the centre & on the margin.

 

Ros has just looked - says that IF it is very painful on weightbearing, it could be a pyogenic granuloma. Whatever, it looks very nasty. Also, what about a "Bairnsdale Ulcer"

 

looks malignant suggest urgent referal to dermatologist

 

Bit more history would be grand;

Onset and duration of lesion?
Age and occupation of patient?
Medical history?, etc.

Who took the original biopsy?

That said, it has the appearance of SCC...So refer on urgently!

 

Bit more time to reply;

IMO, this lesion has the appearance of a type of SCC; verrucous carcinoma, with the classic boggy/fungating mass with a thick white core, an ulcerated centre and an elevated and irregular border.

They are not that common, but they are frequently misdiagnosed for verruca vulgaris. They tend to be invasive but not, apparently, metastatic..

Great pic BTW

Hope that helps!
Bel

 

Can I ask , Has the pt undergone any previous Tx acids, cryo ect ??

I've had a pt come to me with a similar lesion that had cause phlebitis right up his leg and was in a very serious state after Tx from another pod with cryo.
Just a thought
Cheers
D;)

 

This lady came to me as her usual podiatrist is away who has been treating this as a wart for some time, She is unaware if it has changed in its appearance due to her age and inability to see the lesion.... She was born in 1931 and states home duties as her occupation. Pain on weight bearing is occurring. I am unsure who took the biopsy at this stage but it was initiated by her doctor. She would weigh 60kilograms (sorry..I am Australian). I referred her back to her G.P. but she is unable to get an appointment until the 13th August for a referral to a dermatologist.
Thank you for your opinions. They are appreciated.

 

yes, she has been using duoderm paint from her pharmacist, but has subsequently had her podiatrist applying silver nitrate topically and attending for review & sharp debridement, but the photo is how it presented to me

 

No need to apologise for being Australian....I actually met quite a nice one at the Summer School this year ;)

Anyway, I reckon you`ve done everything within your power to ensure your pt receives the appropriate care. Any chance of letting us know the outcome?

Thanks for sharing an interesting case :drinks

Cheers,
Bel

 

will do. She off to the doctor today so fingers crossed.

 

Anything back on the ulcerated heel yet? Whatever it turns out to be, I'd have considered it as highly suspicious - squamous cell carcinoma, even possible amelanotic malignant melanoma - did the patient have many moles ? - and referred at an early stage.

 

I had a patient who had a lesion similar to this and was diagnosed amelanotic malignant melanoma with extensive metastasis. Please consider biopsy, with special instructions to rule out amelanotic malignant melanoma.

 

thanks to all your responses, sorry I have taken so long for the final outcome, but the patient has only returned today: diagnosis "amelanotic malignant melanoma". The area has been excised with a clear margin & skin graft completed. Lymph nodes were clear, so we are now addressing pressure relief.