A Verrucous Plaque on the Abdomen: Challenge
A 58-year-old man with a medical history significant for poorly controlled type II diabetes mellitus and rectal carcinoma status after colectomy and colostomy was admitted to an inpatient ward because of an acute urinary tract infection and acute kidney injury. Shortly after admission, the primary team noticed a thick verrucous plaque on the patient's abdomen near the colostomy site and consulted dermatology for evaluation. The plaque had been present and slowly expanding over the previous year, but the patient denied similar lesions elsewhere. Daily medications included nateglinide, injected insulin glargine, furosemide, ramipril, carvedilol, spironolactone, esomeprazole, and cyclobenzaprine. Physical examination revealed an obese white male with an approximately 5 × 6 cm yellow to brown verrucous pebbly hyperkeratotic plaque on the lower central abdomen below, but not involving, the umbilicus, and near, but not involving, the colostomy bag located on the left lower abdomen (Figs. 1A, B). Examination of face, lips, oral mucosa, scalp, neck, chest, axillae, back, arms, hands (to include palmar surfaces), legs, and feet were otherwise unremarkable to include no similar lesions. A scoop shave biopsy of the plaque was performed (Figs. 1C, D).