Watch & Learn
Punch biopsy
Watch & Learn A how-to video series
A 63-year-old morbidly obese man presented to our clinic with a non-healing, slowly growing, painless ulcer on his right shin that he’d had for one year. It was not actively bleeding or draining, but the scab had come off one month earlier and the wound did not close. The patient denied any trauma to the area or foreign travel. Bacitracin and triamcinolone creams hadn’t helped.
Our patient’s medical history included diabetes, hypertension, hyperlipidemia, and worsening venous insufficiency. He was not currently using compression stockings, but they had helped him in the past.
On examination, we noted a 3 x 3.5 cm well-demarcated, somewhat geometric, clean-based ulceration on the patient’s right medial shin (FIGURE 1A). There was no significant erythema, purulence, tenderness, warmth, or drainage of the ulcer. The base had seemingly normal granulation tissue. Woody induration, verrucous plaques, and confluent erythematous, violaceous, indurated patches were adjacent to the ulcer (FIGURE 1B). The patient also had severe pitting edema on his lower legs.
