ABSTRACT
Verrucous carcinoma (VC) is a rare, low-grade variant of well-differentiated squamous cell carcinoma. Plantar verrucous carcinoma presents as a slow-growing, exophytic, verrucous plaque on weight bearing areas of the foot. Verrucous carcinomas have low metastatic potential, but are high risk for local invasion. We describe a patient with a 20-year history of a slowly growing, ulcerated, verrucous plaque on the sole of the left foot that was erroneously treated for years as verruca plantaris and was eventually diagnosed as invasive verrucous carcinoma. Verrucous carcinomas are a diagnostic challenge due to clinical and histopathologic mimicry of benign lesions. Mohs micrographic surgery should be employed to allow the ability to intraoperatively assess tumor margins while excising the minimal amount of necessary tissue. It is important for clinicians to recognize the characteristics and accurately diagnose verrucous carcinomas. Delays in treatment may require more extensive dissection or amputation.
Subject(s)
Carcinoma, Verrucous , Skin Neoplasms , Warts , Humans , Carcinoma, Verrucous/pathology , Carcinoma, Verrucous/surgery , Carcinoma, Verrucous/diagnosis , Warts/pathology , Warts/diagnosis , Skin Neoplasms/pathology , Skin Neoplasms/diagnosis , Skin Neoplasms/surgery , Male , Mohs Surgery , Diagnosis, Differential , Middle Aged , Diagnostic Errors , Aged , Foot Diseases/pathology , Foot Diseases/surgery , Foot Diseases/diagnosisSubject(s)
Erythema , Skin Abnormalities , Erythema/diagnosis , Erythema/etiology , Humans , Skin , UlcerABSTRACT
Rowell Syndrome is a rare presentation of lupus erythematosus manifesting as an eruption of erythema multiforme-like papules and plaques with immunological findings of positive rheumatoid factor, speckled antinuclear antibodies, and/or anti-Ro/La antibodies. This case highlights the unusual and highly debated presentation of Rowell Syndrome in a 66-year-old woman with newly-appearing erythematous, targetoid plaques in the setting of previously diagnosed systemic lupus erythematosus. Skin biopsy revealed histological features of full-thickness epidermal necrosis with focal sub-epidermal separation and a superficial perivascular lymphocytic infiltrate interpreted to favor Rowell Syndrome given her clinical history and presentation. Although no standard treatment exists, a prednisone taper and topical corticosteroids proved effective initially, with complete resolution at six months on mycophenolate mofetil and belimumab.
