When Suspicious Bilateral Lesions Occur On Prior Hallux Amputation Sites

Author(s): 
Jay Bornstein, DPM, FACFAS, and Larissa McDonough, DPM

   Different forms of treatment options are available for epithelioma cuniculatum. However, the decision process in management may depend upon the invasiveness of the lesion. The recommended treatment of choice in the literature is wide local excision to incorporate affected adjacent structures and decrease the chance of reoccurrence.3,6,8 Partial or complete amputations are also definitive in cases of significantly invasive lesions, poor vascularity, concomitant infections, large soft tissue defects or reoccurrence.8 Electrocautery, cryotherapy, laser treatment and topical chemotherapy have had higher reoccurrence rates and are known more as adjunctive therapy to surgical treatment.4,6,8,15

Final Notes

In our case, wide excision after fresh frozen sectioning was a definitive treatment for this patient. In follow-up appointments for routine care over a year and a half, there has been no recurrence or affiliated issues (see Figures 6, 7 and 8). We found it rare within the literature to have bilateral presentations of epithelioma cuniculatum. The presentation does correlate with multifactorial influences of trauma including acute injury to the area as well as former ulceration sites. It was unknown if the patient has been exposed in the past to variants of HPV.

   Dr. Bornstein is a Fellow of the American College of Foot and Ankle Surgeons, and is in private practice in Winter Park, Fla.

   Dr. McDonough is a third-year podiatry resident at Florida Hospital East Orlando in Orlando, Fla.

References

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