Same Day Appointments Available **






February 10, 2015
Category: Uncategorized
Tags: foot   skin   lesions   Chattanooga foot tumor  

     There are many instances where a biopsy of skin, other soft tissue, or bone is indicated in the foot and ankle.  Today, we will discuss just two cases where a simple biopsy is indicated.  These include PIGMENTED LESIONS and  DERMATITIS (or rashes).  In the foot and ankle, these are the two most common reasons for doing a skin biopsy.  

    Pigmented lesions are often benign.  In fact, on the foot and ankle it is probably safe to say that MOST pigmented skin lesions are benign.  Even the most professionally  trained and experienced physician  cannot always determine whether something is BENIGN or MALIGNANT just by the way it looks.  Nevi, also known as "moles" are benign and very common, but some nevi can become malignant.  A malignant melanoma, typically the most dangerous malignant skin lesion seen on the lower extremity, can often look like a wart.  It doesn't  have to look "black" or "multi-colored" or "eroded" or "ulcerated."   Also, malignant lesions on the lower extremity ofen look different than they do on other parts of the body.  Thinking that "it is probably a mole" can be very risky.   Basal cell and squamous cell carcinomas can also occur on the foot, and while not as deadly as a melanoma, if left unchecked they can result in significant deformity and can metastasize, leading to death.  A suspicious lesion can be easily removed from the foot using either a biopsy punch (a small, disposable device) or with a shave technique.  Either of these can be done under LOCAL anesthesia, and usually in 5 to 10 minutes.  In most cases, stitches are not needed, especially if the involved area is small.   Although the vast majority of these come back benign, more and more malignant lesions are being seen in the foot and ankle.  Definitive diagnosis is crucial.  

    A skin rash or dermatitis can also be easily biopsied, and often involves using a very small biopsy punch (2 mm in many cases) with a small amount of local anesthetic (often only 1.0cc).  This is particularly useful in cases of "Athlete's foot" (a fungal infection of the skin) that does NOT improve with antifungal medication.  Many cases of suspected Athlete's foot are NOT fungal infections at all.  They often turn out to be contact dermatitis, eczematous dermatitis, psoriasis, or other skin problems that are not infectious.  No amount of antifungal or antibiotic medication will help a skin problem that is allergic in nature,  or due to somehing other than an infection.  A skin biopsy can save the time and money involved in trying one medication after another, seeing no improvement, only to realize that what looked like a fungus was not a fungus at all!  Some dermatopatology labs (BAKO Labs, for example, who we utilize for ALL of our pathology specimens) not only can make a definitive diagnosis using a very small piece of skin, but can make treatment recommendations based on the microscopic appearance of the specimen.  This is invaluable when a patient is suffering with an itching, blistering, or dry and scaly skin rash for which nothing that has been tried, over the counter or prescription has helped.  

    There are MANY more cases where biopsy of lower extremity conditions is necessary and very helpful.  These can include NERVE FIBER DENSITY studies, FINE NEEDLE ASPIRATION, BONE BIOPSY and many more.  If you, or someone you care about, has something on the foot, ankle, or lower leg that just "doesn't look right", it may be time to get it checked out.  Please call us with any questions regarding a foot or ankle problem that needs to be checked out .  It may be nothing, but it also may save your life!


Richard S. Eby,. DPM