Rapidly Growing Finger Lesion

A 66-year-old man presents to the clinic with a small, bright red bump on his left ring finger, which he noticed about 1 to 2 months prior to presentation.

History. The patient has a medical history of hypertension but is otherwise healthy. He denies any provoking factors like trauma to the finger, use of medications, insect or animal bites, or new chemical exposures.

The bump has been growing since onset. He states that the lesion is painful, especially when manipulated or snagged. There is no itching or spontaneous drainage. The patient attempted to cut the bump off at home once. The laceration bled significantly for about 1 hour, which eventually resolved after applying constant pressure to the site. The bump has since grown back. He has been dressing the lesion with an over-the-counter wart bandage and applying salicylic acid several times daily for the past 2 weeks with no improvement. The patient reports having similar smaller skin-colored bumps on the right hand 1 month prior to presentation, which were removed by cryotherapy at his dermatologist’s office. The treatment was not applied to the current lesion of interest because it was very small at the time.

On physical examination, a single, firm, red pedunculated papule measuring less than 1 cm was noted on the left ring finger (Figures 1 and 2).

Figure 1. Lateral view of the red, pedunculated papule of the skin over the middle phalanx of the left ring finger (4th digit).

Figure 2. Aerial view of the red, pedunculated papule of the skin over the middle phalanx of the left ring finger (4th digit).

Diagnostic testing. There was no indication for diagnostic testing at the clinic based on the clinical history and the clinical findings of an erythematous papule that bleeds easily and had developed over a few weeks. However, a dermoscopic examination and histopathologic confirmation may be helpful with differential diagnosis.

Excisional biopsy is the optimal diagnostic testing, which was carried out on our patient due to the pedunculated papule form, size, and location of the lesion. The tissue was placed in formalin and sent to the laboratory for pathologic examination for diagnosis confirmation.