Inflamed Verruca

The mother of a 7-year-old girl noticed the rapid progression of a lesion on her child’s right hand over 3 weeks. Within several days of its initial appearance, the very small, nontender, and nonpruritic lesion had grown in circumference and “looked like a wart,” according to the mother. Application of over-the-counter preparations failed to resolve the lesion. A week before the office visit, the lesion “started growing straight up.” On examination, the lesion measured 5 mm in diameter and 7 mm in height; it was friable at the base and tender to touch from constantly being “snagged” by the child’s clothes. The projected surface appeared keratic; however, the cylindrical base was obviously fleshy. The surrounding skin had a verrucous appearance. An elliptical excision was performed to remove the lesion; and a suture was placed. Pathologic findings identified an inflamed verruca, or common wart. Stephen L. Buse, MD, of Dumas, Tex, writes that the initial differential diagnosis based on clinical examination included verruca, cutaneous horn, actinic keratosis, seborrheic keratosis, and squamous cell carcinoma, since all of these conditions may contain keratin and produce horns. Because of the patient’s age, a verruca or cutaneous horn was more likely. At follow-up, a week later, the suture was removed; the incision had healed well without any complications.