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Off-Center Fold
Aug 2011

A Bonelike Protrusion on the Toe —Quiz Case

Author Affiliations
 

SECTION EDITOR: MARY S. STONE, MD; ASSISTANT SECTION EDITORS: SOON BAHRAMI, MD; CARRIE ANN R. CUSACK, MD; SENAIT W. DYSON, MD; MOLLY A. HINSHAW, MD; ARNI K. KRISTJANSSON, MD

Arch Dermatol. 2011;147(8):975-980. doi:10.1001/archdermatol.2011.195-a

A 32-year-old man presented with a 6-month history of a nodular lesion with eroded surface on the second toe of his right foot. The patient was referred to our center after several courses of cryotherapy without improvement. He had no clinically significant previous trauma or medical history. The clinical impression at the initial visit was verruca vulgaris, and cryotherapy was again attempted. However, on follow-up, the lesion appeared to be inflamed with some discharge. After the inflammation had subsided with administration of oral antibiotics, a second session of cryotherapy was tried, but the lesion did not appear to improve. Instead, a hard, dermalnodule with a keratotic surface was revealed under it (Figure 1). A radiologic examination (Figure 2) and incisional biopsy were performed. Some histologic findings are shown in Figure 3.

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