F 69, small painful nodule, left heel

    A 69-year-old white female noticed a small painful nodule on the heel of her left foot. On clinical examination, the nodule measured approximately 1 cm in diameter. The skin surface was uneven but not ulcerated. The patient denied any history of trauma. Clinical impression was “wart”. The patient underwent a wedge excision of the lesion.

    Microscopically, the center of the lesion contained a pointed wooden splinter (approximately 0.7 cm in length), with abscess formation and granulomatous reaction in the dermal tissue surrounding the splinter (Figure 1). Special stain (GMS) was negative for fungus. Viral changes were not noted in the epidermis.