pirate3d@hotmail.com

The subject is diagnosed with a benign "squamous papilloma" on the
exterior of the ankle but it does not fit the descriptions of such
revealed by a google search. Surgical removal is being recomended.
The lesion was found after removing a scab about 1/4 inch or so in
diameter that had remained in place for at least a couple months.
Found underneath is a hollowed out cavity that simply bled again
forming
a new scab. If it is cleaned with a swab it will bleed profusely, then
scab over. After over a year of failed treatments, such as
epsome salt soaks, trace bleach soaks, hydrogen peroxide, herb
poultice, oil of oregano, antibiotic creams, internal antibiotics,
steriod, and silver creams with no healing, a biopsy showed the
diagnosis. Blood work shows no anomolies.

A search on "squamous papilloma" talks more about warts and other
"growths", not something that appears to be creating a cavity in the
skin, eating it, and not healing. When the lesion is kept treated with
prescribed cream and bandaged it stays cavitated and has a light or
white colored bottom. It appeared to try to heal the most from
internal antibiotic but never quit made it. It is not to the bone but
surely through most all the layers of skin.

Anyone recognize this and can explain it?

stanbro

It does sound odd for a squamous papilloma. I'm not a doctor, but the
central crater makes me think of basal cell carcinoma. On the other hand, a
biopsy is more likely to give a correct diagnosis than just visual
inspection. In any case, removal sounds like a good idea, especially after
having had it so long and trying so many things.

The best online pathologist I know is Ed Friedlander "The Pathology Guy" who
has an excellent site (http://www.pathguy.com) and who answers questions when he
can (he gets hundreds every week and can't always get to them all since he
teaches and does a zillion other things). You can write him at erf@uhs.edu.
If he doesn't know, he will sometimes pass the question along to someone
else. He might be willing to review your slides or tell you someone in your
area who would give you a second opinion. If the thing indeed turned out to
be a basal cell carcinoma after all, or some other kind of malignant tumor,
you'd probably want more aggressive surgery than if it is just a benign
papilloma, so it might save you a second operation to get the diagnosis
right the first time.

Good luck,
Helen S.

sean

"warts" are caused by one of the papilloma viruses, it may be post viral
reaction causing a necrotic lesion

steph

You won't have the answer until it's been removed, which should also solve
the problem

jedilworth

Has this lesion ever been cultured for acid fast bacilli? Since I work
in microbiology I am obviously prejudiced, but perhaps, given the
chronic nature of this, a fungus or acid fast bacteria should be looked
into.

I'm just speculating here, mind you. If pathology has been done on this
lesion, they obviously know more than I do.

Judy Dilworth, M.D. (ASCP)
Microbiology

katra

M.D.???
You sure that's not M.T.? ;-)
Sorry, could not resist... <G>

I'm sure, with the numerous sections and biopsies done on these lesions,
your pathologist would have at least seen some bacteria in them, even
with just the regular histology stains... Check the Path. reports in
your OC computer system.

Why don't you ask them, next time they get in a fresh frozen section, to
let you have some of the tissue to play with? At least do an acid fast
stain, or plate to LJ agar if you have it in your lab.

We work very closely with our Pathologists and they are usually open to
such personal research.

Be sure to culture it for viruses also if you can. That is far more likely.

Regards, Katra M.T. (ASCP)


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pirate3d@hotmail.com

A punch biopsy was performed and the lab could not determine what it
was, only that it was benign, thus a squamous?
I did not see this report but wish to get a copy.
The lesion was removed two weeks ago and on one of the forms I signed
I said I wanted the removed tissue. They thought this was quite
strange and did not give me my removed skin.
I also was put under general anesthetic without my permission when
this could easily have been performed under local. The Dr. and I had a
disagreement about the need for a skin graft. I am near positive this
guy was trying to milk me and my insurance for extra uneeded surgery.
I had made a written change to their form and denied them use of
general anesthesia. In a pre-op discussion with the anesthesiologist
and the surgeon it was agreed to use a local from my knee down since
the lesion was on my ankle. And on my other leg if graft was needed. I
also have a spinal injury that has left me with no pain sensation
below my chest making even a local uneccesary. I was to be awake for
the proceedure. I didn't trust this guy that much as he had already
overlooked things in prior examinations. They lied to me, nurses
included, and once on the table stuck an IV in me and I was out like a
light for about 2 hours.
One wonders why people don't trust Dr,'s these days when they do shit
like this.
I will not return to the Dr. or clinic and will be removing my own
stitches in about another week. Also planning to sue the Dr. for
malpractice. Asshole deserves to have his license revoked.

john gentile

I can't answer your questions about being under general instead of local,
but I do know that the skin biopsy that they send to the lab is usually a
tiny sample and the entire piece is embedded in a waxy block and thin slices
are shaved for staining. The Pathologist will then examine the slides for
pathologic conditions. There is no piece that can be returned to you.

--
John Gentile Secretary, Rhode Island Apple Group
yjgent@cox.net RIAG Web page: http://www.wbwip.com/riag/
"I never make mistakes, I only have unexpected learning opportunities!"

john gentile

Anything removed from the body in surgery goes to the pathology lab for
exam. In your case I would think that the biopsy results were compared to
the whole specimen to see if they agree. Still there would not be any
specimen to "take home". As far as I know, the only surgical removals that
might be given to the patient are stones.
--
John Gentile Secretary, Rhode Island Apple Group
yjgent@cox.net RIAG Web page: http://www.wbwip.com/riag/
"I never make mistakes, I only have unexpected learning opportunities!"

stanbro

It does sound odd for a squamous papilloma. I'm not a doctor, but the
central crater makes me think of basal cell carcinoma. On the other hand, a
biopsy is more likely to give a correct diagnosis than just visual
inspection. In any case, removal sounds like a good idea, especially after
having had it so long and trying so many things.

The best online pathologist I know is Ed Friedlander "The Pathology Guy" who
has an excellent site (http://www.pathguy.com) and who answers questions when he
can (he gets hundreds every week and can't always get to them all since he
teaches and does a zillion other things). You can write him at erf@uhs.edu.
If he doesn't know, he will sometimes pass the question along to someone
else. He might be willing to review your slides or tell you someone in your
area who would give you a second opinion. If the thing indeed turned out to
be a basal cell carcinoma after all, or some other kind of malignant tumor,
you'd probably want more aggressive surgery than if it is just a benign
papilloma, so it might save you a second operation to get the diagnosis
right the first time.

Good luck,
Helen S.