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November 1992

A Painful Step

Author Affiliations

USA; USA; USA Uniformed Services University of the Health Sciences, Bethesda, Md, and Brooke Army Medical Center, Fort Sam Houston, Tex

Arch Dermatol. 1992;128(11):1533-1534. doi:10.1001/archderm.1992.01680210111017

REPORT OF A CASE  A 45-year-old black man presented to the dermatology clinic complaining of a tender pink nodule on the instep of his left foot. Two years previously, he had noted a blister in the same area after wearing a new pair of Army boots. The blister resolved but a small papule developed in its place. There were no symptoms until 2 months before presentation, when he experienced occasional bleeding and pain when wearing certain types of shoes. He denied ulceration, drainage, or itching. He noted the lesion had grown. He was otherwise in good health, not receiving any medications, and had an unremarkable medical history.Findings from his physical examination revealed a wellcircumscribed exophytic nodule arising within a shallow cuplike invagination of the skin. It measured 0.8 cm at its greatest diameter (Fig 1). A saucerized shave biopsy of the lesion was performed. Tissue culture of the lesion