04/14/2012    

RESPONSES / COMMENTS (CLINICAL) - PART 2

RE: Excisional Biopsy (Joe Borden, DPM)

From: Gino Scartozzi, DPM

 

The lesion as described by the practitioner as "pulsatile" concerns me as to whether there has been adequate pre-operative planning. The fact that the lesion easily bleeds and has developed after trauma strongly suggests a granuloma or hemangioma of some variety. A lesion of this size and clinical presentation may be a possible cavernous hemangioma.

 

I recommend prior to performing an "excisional biopsy" on the region of the heel, an MRI be obtained to determine if there is a larger arterial-venous malformation plexus present beneath the skin that may be hidden to the practitioner. If such vascular etiology is found, a vascular consultation may be requested pre-operatively. In addition, the skin coverage on the heel of a lesion as described as 2 cm x 5 mm may require plastics consultation pre-operatively to determine which method of closures are available, since skin mobilization for closure in this region of the foot is more difficult than in other regions of the foot. An "incisional" biopsy, dependent on the MRI results, may be obtained and would be more beneficial to determine the etiology (malignant vs. benign.) When the determination of the lesion's malignancy potential is found, the lesion's skin closure and treatment with an oncologist can be better planned.

 

Gino Scartozzi, DPM, New Hyde Park, NY, Gsdpm@aol.com