PMC4473813_01
Clinical and histological findings. (a) A verrucous skin lesion on the dorsum of the left third metatarsal head. (b) Close-up of the lesion. (c) Skin biopsy specimen showing epidermal hyperplasia and elongation of the rete ridges. (d) Individual cell keratinization and mild atypism were observed.
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PMC4473813_01_eplasty15e23_fig1.jpg
F1
Consequently, the patient was referred to our department, where a physical examination revealed a cauliflower-shaped hyperkeratotic nodule measuring 20 x 22 mm (Figs 1a and 1b). Histologically, epidermal hyperplasia and elongation of the rete ridges were observed, and mild atypism was recognized at the basal layer (Figs 1c and 1d), thus necessitating differentiation between VC and pseudocarcinomatous hyperplasia.
Radiograph and computed tomographic scan. (a) Radiograph showing the presence of skin staples (arrow) at the amputation stump. (b) Computed tomographic scan showing the lesion (arrowhead) overlaying a residual skin staple (arrow); no tumor invasion to the surrounding tissue was evident.
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PMC4473813_01_eplasty15e23_fig2.jpg
F2
Several skin staples used in the previous skin grafting were detected on the radiograph of the left foot (Fig 2a), and the third toe was dislocated toward the amputated site. Computed tomographic scans showed that the skin lesion was overlaying the residual skin staples; however, no tumor invasion to the surrounding tissues was observed (Fig 2b).
Preoperative and postoperative findings. (a) Resection with a 1-mm horizontal margin was performed. (b) Artificial dermis placed onto the skin defect. (c and d) Resected verrucous nodule with skin staples (arrow).
eplasty15e23_fig3.jpg
PMC4473813_01_eplasty15e23_fig3.jpg
F3
The lesion, along with a 1-mm margin (Fig 3a), was resected concurrently with the partial second metatarsal bone, and artificial dermis was placed onto the defect (Fig 3b). Moreover, the residual skin staples found just beneath the lesion (Figs 3c and 3d) were removed.
Histopathology of pseudocarcinomatous hyperplasia. (a) Epidermal hyperplasia and elongation of the rete ridges were observed. (b) No atypia was noted in the elongated rete ridges. (c) Invasion of inflammatory cells was recognized around the skin-stapled site. (d) Two years after the last operation.
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PMC4473813_01_eplasty15e23_fig4.jpg
F4
Histologically, epidermal hyperplasia, elongation of the rete ridges, and invasion of inflammatory cells (Figs 4a-4c), features characteristic of pseudocarcinomatous hyperplasia, were observed. Figure 4d shows the status of the foot 6 years after the last operation.