A 44-year-old woman reported having severe peripheral neuropathy and uncontrolled type 2 diabetes. Further examination showed the presence of growth under the plantar aspect of the first MTP joint (image A). While her other lesions had a dull pain associated with them, this particular lesion was sharply painful. In time, the lesion started draining a pungent toothpaste-like substance and took on the appearance of a "cauliflower." The dermatologist performed a wide excision of the lesion.
Two years later, the patient developed another acutely painful lesion under the planer aspect of her 5 th MTP joint in her left foot (image B). Image C shows the left foot after the Mohs resection. Prominent verrucous epithelial hyperplasia along with focal atypia was observed in pathological tests. Later that year, the patient’s right second toe had to be amputated due to complications arising from the…
