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Case Reports

Abstract

A 47-year-old man with Fitzpatrick Type V skin, in remission following chemotherapy for Hodgkin’s lymphoma, presented with a growth on his left foot. He denied antecedent trauma but noted pain and bleeding when the lesion rubbed his shoe. Examination revealed a pink, pedunculated, bloody, scaly and crusted papule with background moccasin-foot tinea pedis. Dermoscopy highlighted a hyperkeratotic rim. The papule was above the Wallace Line, the line of demarcation between glabrous plantar skin and hair-bearing skin of the dorsal foot. Histopathology demonstrated a circumscribed, inflamed papule with the characteristic monomorphic cuboidal cells and hyalinized vascular stroma of poromas. Fungal stain demonstrated hyphae. Benign adnexal tumors, poromas arise from acrosyringium, classically presenting as asymptomatic papules on palms and soles. Pathogenesis is unknown. Associations include HPV infection, trauma, scarring, and radiation. Multiple poromas, termed “poromatosis,” are reported after chemotherapy. Cytotoxic damage to eccrine glands is likely a predisposing factor. Superimposed tinea pedis, in this case, may have contributed to symptomatology. This is a unique case of a pedunculated poroma with superimposed tinea pedis, above the Wallace line of the foot, in a Black patient. Poromas are uncommon; pedunculated poromas are especially rare.  Poromas typically occur on eccrine dense skin of palms and soles rather than glabrous skin as seen in this case. Predilection for sex or race is not reported. In one unpublished abstract, our group described poromatosis in a Black man following AML treatment. However, thorough literature search failed to identify other reports of poromas in patients with skin of color.