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February 2010

A Nontender Nodule on the Tip of the Left Index Finger—Quiz Case

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Copyright 2010 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2010

Arch Dermatol. 2010;146(2):191-196. doi:10.1001/archdermatol.2009.367-a

A 59-year-old man presented with a 6-week history of a growing lesion on the tip of his left index finger (Figure 1). He is an active gardener who denied recent trauma to his hands or fingers. His medical history was unremarkable. On physical examination there was a nontender, skin-colored hard nodule measuring 1.4 × 0.6 cm, located at the distal phalanx of the second finger. There was no limitation in passive or active movement of the finger, hand, or wrist. There was no regional lymphadenopathy. Immediately after a punch biopsy was performed, a residual irregular yellowish-white mass was noted at the base of the biopsy site. A reexcision was performed after the results from the initial biopsy were received. Sections from the initial biopsy and high-power magnification of the reexcision specimen are shown in Figure 2 and Figure 3, respectively.

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