A 67-year-old man has had a small lesion on his index finger for several years. Recently, it has grown large enough to start interfering with his normal activities. The lesion is not painful unless the patient bumps it—but as it grows, avoiding such incidents is becoming more difficult.
The diagnosis has thus far been a mystery: What is it? The patient’s primary care provider didn’t know and, per the patient’s report, had no interest in trying to remove the lesion. Thus, the patient finds himself referred to dermatology.
The patient can recall no specific injury. He does, however, report that he worked for years as an upholsterer, shaping, sewing, and stapling heavy fabric onto chairs and sofas—often puncturing his fingers in the process.
His health is otherwise “decent.” He is taking medication for hypertension and an a-blocker due to “problems” with his prostate.
EXAMINATION
The finger lesion is a 2-cm, round, firm nodule with a smooth, telangiectatic surface. It is located on the perionychial area of patient’s index finger (lateral aspect). The lesion is attached to the finger by a broad base that rises seamlessly from the skin. It is not translucent or tender to touch. No similar lesions are seen on either hand, and no nodes are felt in the epitrochlear or axillary locations.
Within a few weeks, the patient returns to have the lesion excised. This is done with a combination of a digital block and local anesthesia, with a tourniquet to control bleeding. After primary closure, the lesion is submitted to pathology. The report indicates the lesion is a cyst, full of cheesy material.
What is the diagnosis?