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Spring 2020, Vol. 28 No. 1

Hong Kong J. Dermatol. Venereol. (2020) 28, 34-35


Dermato-venereological Quiz

Dermato-venereological Quiz

CMT Cheung 張敏彤, AWS Chan 陳慧詩, PCL Choi 蔡祥龍

A man with long standing warty plaque on ankle

A 63-year-old Chinese man presented to dermatology clinic with warty plaques on the left posterior ankle for over 20 years. He had a burn injury over the region in childhood. There was no other significant past medical history. The lesions had limited response to multiple cycles of cryotherapy previously.

Examination revealed verrucous plaques on the left posterior ankle, with underlying scar tissue from previous burn injury (Figure 1). An incisional skin biopsy was obtained for histological and microbiological evaluation (Figures 2, 3 & 4).

Figure 1 Verrucous plaques on the ankle.

Figure 2 Skin biopsy. Haematoxylin & eosin stain, magnification x20.

Figure 3 Skin biopsy. Haematoxylin & eosin stain, magnification x200.

Figure 4 Skin Biopsy. Ziehl-Neelsen stain, magnification x400.

Questions

  1. What are the clinical differential diagnoses?
  2. What does the biopsy show?
  3. What is the diagnosis?
  4. What is the management?