A 29-year-old African American man with long-standing type 1 diabetes mellitus, hypertension, retinopathy, nephropathy, and peripheral vascular disease that had resulted in leg amputation above the knee presented with a 4-year history of a verrucous lesion on his foot. It had been stable in size for 3 years but had intermittently ulcerated and healed. He had been seen by numerous physicians for what was thought to be a diabetic ulcer with a surrounding callus.
On physical examination, the patient was found to have a hyperkeratotic, partially ulcerated verrucous plaque on the plantar surface of his forefoot (Figure 1). No other verrucous lesions were noted. A podiatrist obtained a wedge biopsy specimen after attempts at healing were unsuccessful (Figure 2).
Ho J, Diven DG, Butler PJ, Tyring SK. An Ulcerating Verrucous Plaque on the Foot. Arch Dermatol. 2000;136(4):547-552. doi: