Images in Clinical Medicine

Growing Plaque on the Foot

Bryan E. Anderson, M.D., and Elizabeth Billingsley, M.D.

N Engl J Med 2005; 352:488February 3, 2005

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A 64-year-old woman presented to our clinic with a 20-year history of a slowly growing plaque on her left foot. This lesion had been pared and a biopsy reportedly performed in the past, but the patient's concomitant mental illness had made her very reluctant to undergo treatment. She ultimately sought treatment because of increasing pain and difficulty walking, as well as drainage and odor. On examination, a large, hyperkeratotic plaque with multiple horny projections was found. The central portion was friable, and after some débridement, an underlying abscess was discovered. An excisional biopsy revealed verrucous carcinoma. A radiograph revealed no underlying involvement of bone.

Verrucous carcinoma is a slow-growing variant of squamous-cell carcinoma. It may resemble a wart and, when found on the plantar surface of the foot, may be called carcinoma cuniculatum. These tumors rarely metastasize, and surgical excision is recommended.

Bryan E. Anderson, M.D.
Elizabeth Billingsley, M.D.
Penn State University College of Medicine, Hershey, PA 17033-0850