History: A 71 year old white male presented with a non-healing wound on the dorsum of his left hand. Approximately 2 months ago he caught his hand in an elevator door resulting in an avulsion injury to his skin. He used butterfly bandages to tape the skin in place. The area failed to heal over the course of 1 month and he was prescribed cephalexin for cellulitis by his primary care physician. This resulted in no improvement and he was referred to the dermatology department.
Past Medical History, medications, family history: non-contributory
Social history: Avid fisherman. He admits to fishing a couple days after the initial injury and immersing his hand in lake water, bait containers, and handling his catch. Denies travel outside the Midwest.
Physical Exam: significant only for an erythematous
verrucous plaque on the dorsum of the left hand (Figure 1)
Click here for the Diagnosis.
Click here for CME Credit