An immunocompetent elderly man came to us with a slowly progressive asymptomatic verrucous outgrowth [Figure 1] over the sole of the left foot for 20 years, causing difficulty in walking and wearing footwear. On examination, seborrheic keratosis-like lesions and pityriasis versicolor-like lesions were present on the trunk. Lesions suggestive of mosaic warts were present over both the palms and soles [Figure 2]. There was a history of similar wart-like lesions in the mother. A diagnosis of hereditary Epidermodysplasia Verruciformis was made. Histopathology of the verrucous lesion was done, and epidermis showed hyperkeratosis, acanthosis, papillomatosis, and a few koilocytes. In the dermis, a mild perivascular lymphomononuclear infiltrate was present. There was no feature to suggest squamous cell carcinoma (SCC). The patient was put on prophylactic retinoids to prevent the development of SCC.
Figure 1.
Tree-bark-like appearance of verrucous plaque present over the left sole of the patient
Figure 2.
Mosaic wart-like keratotic lesions present over both palms
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Acknowledgement
We thank the patient for granting permission for clinical photography.