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Dermatology Discussion

Growth on the Left Foot

New York United Medical Center, New York

January 2005

Presenters: Suleman Bangash, Chief Resident and Carissa Summa, Second Year Resident

Program Director: Cindy Hoffman, D.O.

Clinical Presentation

43 years old African-American female

History

Chief Complaint: “Growth on my left foot”

Signs and symptoms: Lesion was slightly tender to palpation

Previous Treatment: None

Other Information: The patient had a past medical history significant for Milroy’s disease (Congenital Lymphedema). She reported that the lesion began as a brown patch and slowly enlarged to a dome-shaped nodule over several years. She also reported multiple similar, but smaller lesions on her upper and lower extremities and trunk. The patient was only taking Hydrochlorothiazide for the lower extremity edema.

Physical Examination

A 3.0 X 3.2 cm, slightly hyperpigmented, soft, pedunculated nodule was present on the left dorsal foot. A total of nine hyperpigmented, firm 0.5 – 1.0 cm nodules were found on bilateral upper and lower extremities and trunk.

Laboratory Tests

A shave biopsy of the left dorsal foot lesion was done.

Dermatohistopathology
Microscopic description: Spindle cell tumor composed of fibroblasts, histiocytes, and multinucleated giant cells in the dermis. The overlying epidermis is hyperplastic with elongation of rete ridges.

Differential Diagnosis