About five months ago, a 47-year-old male came to my office complaining of pain below his left fifth metatarsal head. He stated that he had this wart on his foot for as long as he could remember. He had prior treatments but it never really seemed to go away. The patient also stated a history of basal cell carcinoma.
I decided to perform an excisional biopsy in my office. This was not so much because I thought it might be cancer but because it was a deep, intractable, hard piece of skin. I felt no other treatment would really be ideal for this and I was not really sure it was a wart. The thicker the wart, the more likely I am to remove it surgically.
I performed the biopsy and then got a call the next week from the pathologist, who just happens to specialize in verrucous carcinoma. He told me it was most likely a low grade carcinoma and needed a wide excision. I called the patient, gave him the bad news and referred him to a surgical oncologist. Sure, I could have performed the wide excision myself but I felt that he would be better served by someone who deals with this a lot more than I do.
I think we can all learn from this situation and biopsy more than we presently do because you just never know. This is why it is important to get a history and be sure to review any prior treatments as well as any disease processes that might cause an immunocompromised state or reveal a history of cancer.