PMC5896404_01
Exophytic lesion at the base of the first MTP joint of the right foot within a chronic diabetic ulcer. Pathology confirmed this lesion to be verrucous carcinoma.
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She described this lesion as "sharply painful"; her other ulcers caused her a "more dull pain." Eventually, the growth became cauliflower-like and drained a pungent, toothpaste-like substance.  Figure 1 shows this exophytic lesion within a diabetic ulcer prior to excision.
Painful exophytic lesion on the plantar surface of the left 5th MTP joint, which, after multiple biopsies, was confirmed by pathology to be verrucous carcinoma.
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Throughout early 2015, the patient and her home care team noted an acutely painful lesion on her left foot on the plantar surface of the 5th MTP joint (Figure 2).
Representative medium power image of the verrucous carcinoma demonstrates prominent surface hyperkeratosis and marked epidermal acanthosis, with a combined exophytic and endophytic growth pattern. Cytologic atypia is only mild to moderate. Rather than the infiltrative pattern typically seen at the deep edge of conventional invasive squamous cell carcinoma, verrucous carcinoma demonstrates insidious pushing-type invasion by expansile and irregular rete pegs (4x, H&E stain).
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May and July of 2015, all showing VC. Mohs resection of the tumor was performed, showing complete resection of the lesion.  Figure 3 shows the left foot after Mohs resection of this lesion.