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Dr. David B. Raynor, Best Foot Forward, 12/25/12

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Take time to check out lesions that persist

By Dr. David Raynor

Lesions that persist or won’t heal should be biopsied. Corns, calluses and warts are common skin issues podiatrists see. These issues often cause people discomfort that leads them to seek relief.

Patients with symptomatic corns and calluses can usually be offered relief fairly easily. Debridement, offloading padding or sleeves, inserts and shoe changes or modifications generally are all that is needed to provide relief for a patient’s complaints.

Warts are a much more difficult proposition in my experience. Warts almost always need forms of topical medication, injection, and surgical measures in addition to the treatments for corns and calluses to provide relief.

Ulceration is another common lesion a podiatrist sees. Causes of ulceration include, but are not limited to, insect bite, chemical or thermal burn, venous insufficiency, edema, peripheral artery disease, diabetic complications, infection, immunosuppression and neuropathy, to name a few.

Podiatrists, nurses, wound care specialists, surgeons and dermatologists have training and experience that allows them to more precisely diagnose lesions and wounds, their cause, and the most appropriate treatment by obtaining a history of the problem, the patient’s current health issues and examining the wound and any testing that was performed.

I can very easily differentiate a wart from a callus or corn, as I have 18 years of experience in dealing with these issues. I can very easily determine venous stasis ulceration just by the appearance of the wound.

There are times, however, it is not that simple.

There are times when I tell a patient, “I don’t know. I’ve never seen that before.” This can apply to the visual or palpable appearance of an issue or lesion, or the way a problem resists therapy that should provide benefit.

Wounds that do not heal in a reasonable fashion that should with the prescribed treatment, or those that appear different or act differently than one would expect should be biopsied.

A biopsy of tissue usually can be performed in the office setting and only require a small amount of local anesthesia. A small 3-mm to 4-mm punch is used to obtain a full-thickness sample of the lesion or wound for the pathologist to study. The wound is often just cauterized and infrequently requires a suture.

This is the definitive method of diagnosis. The diagnosis is confirmed by the biopsy and the patient and physician will know the cause and best method of treatment.

Squamous cell carcinoma occurs on the foot and leg and can be fatal if untreated and metastasis occurs. Squamous cell can masquerade as a wart or scab that “won’t seem to heal.”

Malignant melanoma can masquerade as an ingrown toenail. Biopsy can lead to a definitive diagnosis for the cause of lesions and wounds.  Proper diagnosis will speed treatment and lead to a better chance of successful, satisfactory outcomes.

Proper diagnosis can help minimize morbidity, expense and complications. Consider a simple biopsy if a wound or lesion persists or is not responding to treatment as you or your physician expects.

David B. Raynor, DPM, is a podiatrist in Inverness and can be reached at 352-726-3668.