Exophytic Digital Lesion

Elizabeth V. Seiverling; Matthew J. Franklin; Jeffrey J. Miller; Catherine G. Chung

May 15, 2017 Issue

Photo Quiz

Exophytic Digital Lesion

ELIZABETH V. SEIVERLING, MD; MATTHEW J. FRANKLIN, BS; JEFFREY J. MILLER, MD; and CATHERINE G. CHUNG, MD, Penn State College of Medicine, Hershey, Pennsylvania

Am Fam Physician. 2017 May 15;95(10):667-668.

A 36-year-old man presented with a self-described “wart” on his finger. It had been present since childhood, although he did not know if he was born with it. The lesion was a nuisance, but it did not itch or bleed and was nontender. It did not resolve with cryotherapy performed approximately 20 years earlier. He had no other similar lesions or significant medical history, including skin disease.

Physical examination revealed a 3-mm, exophytic, firm, flesh-colored filiform papule on the dorsum of the left third finger with slight scaling (Figure 1).

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Figure 1.

Question

Based on the patient’s history and physical examination findings, which one of the following is the most likely diagnosis?

A. Acquired digital fibrokeratoma.

B. Common wart (verruca vulgaris).

C. Cutaneous horn.

D. Myxoid cyst (digital mucous cyst).

E. Supernumerary digit (polydactyly).

Discussion

The answer is A: acquired digital

Address correspondence to Elizabeth V. Seiverling, MD, at eseiverling@hmc.psu.edu. Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

REFERENCES

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1. Kakurai M, Yamada T, Kiyosawa T, Ohtsuki M, Nakagawa H. Giant acquired digital fibrokeratoma. J Am Acad Dermatol. 2003;48(5 suppl):S67–S68....

2. Satter EK. Acquired digital fibrokeratoma. January 23, 2017. http://emedicine.medscape.com/article/1055825-overview. Accessed March 18, 2017.

3. Cahn RL. Acquired periungual fibrokeratoma. A rare benign tumor previously described as the garlic-clove fibroma. Arch Dermatol. 1977;113(11):1564–1568.

4. Hashiro M, Fujio Y, Tanaka M, Yamatodani Y. Giant acquired fibrokeratoma of the nail bed. Dermatology. 1995;190(2):169–171.

5. Longhurst WD, Khachemoune A. An unknown mass: the differential diagnosis of digit tumors. Int J Dermatol. 2015;54(11):1214–1225.

This series is coordinated by John E. Delzell Jr., MD, MSPH, Assistant Medical Editor.

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