funDERMentals

Farmer Flummoxed by Finger Lesion


 

A 70-year-old man self-refers to dermatology for evaluation of a “risin’ in my finger,” which has existed for “at least 40 years.” While the lesion doesn’t really hurt, the patient wants it gone because he traumatizes it almost daily while working on his farm.

He has tried innumerable removal methods, including acids, blood root, and duct tape. Most recently, his primary care provider attempted treatment with cryotherapy.

The patient’s health is excellent in other respects, with no history of similar lesions elsewhere.

EXAMINATION
A dome-like pink nodule is seen on the palmar surface of the patient’s left index finger. The 1-cm lesion is smooth, moderately firm, and nontender. Although the majority of the lesion protrudes above the skin’s surface, there is an intradermal component. Normal skin lines on the surface are preserved, and there is no surface punctum. Palpation of the epitrochlear and axillary areas above the hand reveals no masses.

What is the diagnosis?

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