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BACKGROUND
An 87-year-old Filipino man presents to the emergency department with a protuberant mass on his right heel that he first noticed 2 months ago. Since then, the mass has enlarged and has become increasingly uncomfortable with walking. The mass is otherwise painless, but it frequently oozes blood after walks or minor trauma. The patient denies having previous local trauma or walking outdoors in bare feet. He otherwise feels well, without fever, rashes, leg swelling, systemic symptoms, or other unusual lesions.
On physical examination the patient is a well-appearing, elderly man in no apparent distress who is wearing a blood-soaked bandage over his right heel. On the plantar aspect of his heel is a 2-cm, fungating, nontender mass with areas of central necrosis. The lesion is raised, with ill-defined borders and areas of uneven tan discoloration and erythema. He has no palpable inguinal or popliteal adenopathy, lower-extremity edema, rash, or pathologic lesions elsewhere.
What is the diagnosis? |
Hint
Most of these lesions occur in sun-exposed areas, but a few occur in nonexposed areas. |
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Author:
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Mary B. White, MD, West Los Angeles Veterans Affairs Medical Center, Los Angeles, Calif |
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eMedicine
Editor:
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Erik Schraga, MD, UCLA - Olive View Medical Center Residency, Department of Emergency Medicine, Olive View - UCLA Medical Center |
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