Four Fattened Phalanges
Match the diagnosis to the photo by letter
a. Digital fibromyxoma
b. Dermatofibrosarcoma protuberans
c. Subungual exostosis
d. Onychomatricoma
For answers, see next issue; for discussion, go to www.mdedge.com/clinicianreviews/picture
Case presentations and photographs courtesy of Cutis. Copyright 2018 Frontline Medical Communications Inc.
Answers to November “Picture This” (Clinician Reviews. 2017;27[11]:39): 1c, 2a, 3b
4. A 41-year-old man presents with a slowly growing, tender lesion located on the left great hallux. When it first appeared five months ago, it resembled a blister. On exam today, a firm, 3.5-cm, flesh-colored, pedunculated nodule is seen on the lateral aspect of the toe. No lymphadenopathy is found. The patient reports no history of keloids or trauma to the foot.
Diagnosis: Shave biopsy showed findings consistent with dermatofibrosarcoma protuberans. A chest radiograph was unremarkable. Re-excision was performed with negative margins on frozen section but with positive peripheral and deep margins on permanent sections. The patient subsequently underwent amputation of the left great toe and was lost to follow-up after the initial postoperative period.
,For more information, see “Dermatofibrosarcoma Protuberans.” Cutis. 2017;100(1):E6-E7.
