A 35-year-old Caucasian man was referred to our clinic for treatment of a nonhealing “wart-like” growth on his left index finger. He said that the lesion had been there for at least 2 years and complained of extensive periungual erythema and scaling of the same finger. The patient was immunocompetent and denied trauma, chronic nail infection, arsenic exposure, or radiation to this particular finger. On several occasions, liquid nitrogen cryotherapy had been used on the growth, without improvement.
Physical examination revealed a well-demarcated erythematous patch with scaling involving the medial and proximal periungual areas of the left index finger (FIGURE). There was also a distinct, rough-surfaced 5×4 mm papule with scales, crusts, and small fissures in the middle of the patch. In addition, there was onychodystrophy with keratotic debris on the medial aspect of the same finger. Our attempt to scrape this papule failed and was painful for the patient.
The other nails were normal. Review of the patient’s systems, family history, and personal history were otherwise unremarkable. We biopsied the lesion.
FIGURE
Erythematous patch and rough-surfaced papule
What is your diagnosis?
How would you manage this condition?