It is Saturday afternoon, and the local GP surgery is closed. A very anxious teenager comes in, worried she has a tumour adjacent to her nail on her big toe. Her grandfather died several years ago after a similar looking lesion higher on his leg, which was diagnosed very late as a squamous cell carcinoma.

Questions

1. There is a high chance that this is a malignant skin lesion. True or false?

2. An urgent appointment is not required. However, treatment with antibiotics is required. True or false?

3. One treatment option is the use of silver nitrate, which can be directly applied to the granulomatous tissue. True or false?

4. Once applied, the silver nitrate will cause the skin to turn black. This is normal and will fade with time. True or false?

5. A chiropodist would be a better choice of therapist than a GP in the treatment of this condition. True or false?

DISCUSSION

1. False. Although squamous cell carcinomas can assume many different guises, this type of skin cancer would be very unlikely in a teenager. This is actually granulomatous tissue caused by an underlying in-growing toenail.

2. False. There is no sign of pus or redness in this case to suggest an infection.

3. True. Silver nitrate used for warts and verrucas can be applied directly, and after a few days will cause the tissue to reduce in size.

4. True. However, ideally only the granulomatous tissue should be touched with the silver nitrate and care is required on application.

5. True. Chiropodists can offer a wider range of treatment for in-growing toenails than GPs.