Case at a Glance
A 36-year-old female presents with a new skin lesion on her knee that appeared within one week, concerning for possible wart versus other benign skin growth.
Patient's Story
The patient, a 36-year-old non-smoking female (height 5'7", weight 160 lbs) with no significant medical history or current medications, noticed a new bump on her knee approximately one week prior to presentation. She reports the lesion is non-pruritic and does not demonstrate central depression or fold when pinched. The patient had undergone routine dermatological screening for skin cancer two months earlier with unremarkable findings. Due to lack of insurance coverage, she was seeking guidance on whether immediate dermatological evaluation was necessary and inquiring about potential self-treatment options for benign conditions.
Initial Assessment
Physical examination revealed a solitary, firm, non-tender papular lesion on the knee. The lesion appeared well-demarcated without central umbilication, erythema, or surrounding inflammation. No other similar lesions were noted on initial inspection.
The Diagnostic Journey
Given the rapid onset, location, and clinical appearance, differential diagnosis included viral wart (verruca vulgaris), seborrheic keratosis, dermatofibroma, or other benign skin growths. The patient's recent normal dermatological screening provided reassurance against malignant processes, though the new onset warranted careful evaluation.
Final Diagnosis
Clinical assessment was most consistent with verruca vulgaris (common wart), likely caused by human papillomavirus (HPV) infection.
Treatment Plan
Initial management options discussed included: 1) Watchful waiting, as many warts resolve spontaneously over time, 2) Over-the-counter salicylic acid treatment for home management, 3) Cryotherapy with liquid nitrogen if conservative measures fail, 4) Referral to dermatology if lesion persists, enlarges, or changes in appearance.
Outcome and Follow-up
Patient was counseled on self-monitoring for changes in size, color, or symptoms. Instructions provided for proper application of topical treatments if pursued. Follow-up recommended in 4-6 weeks to assess treatment response, with earlier return if concerning changes develop. Patient advised to seek immediate dermatological consultation if rapid growth, bleeding, or other worrisome features occur.