History: 50 year-old African American female presents with a growth on her right foot. The lesion has been present for the last fifteen years, and the patient relates that it first developed shortly after her son dropped a chair on her right pinkie toe. Initially a small red papule was present, but over the years the lesion has grown to its present size. The lesion is asymptomatic, aside from occasionally becoming irritated when it rubs on her shoe. The lesion has never been treated
Past Medical History: Eczema, Bipolar disorder
Medications: Triamcinolone 0.1% ointment (for eczematous dermatitis, not to lesion), no current treatment for bipolar disorder
Physical Exam: firm periungual pedunculated spiny nodule on right 5th toe (Fig. 1).
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