Giant verruca vulgaris

BACKGROUND. Common warts (verrucae vulgares) are hyperkeratotic papulonodules that are most often seen on the hands, arms, and legs, but they can be seen anywhere on the glabrous skin. Common warts represent the most frequent clinical lesions produced by the human papillomavirus (HPV). OBJECTIVE. Although they are diagnosed easily, giant, chronic, isolated, solitary, recalcitrant verruca vulgaris involving nail and nail bed on the digits can be misdiagnosed, and the differential diagnosis should be made carefully and verified by biopsies. METHOD. A 50-year-old male patient had a giant periungual verruca vulgaris on his left second finger. It was present for 2 years, was unresponsive to any treatment modality, and was treated by surgical excision. RESULTS. After 18 months of follow-up, there was no evidence of recurrence, and both aesthetic and functional results were quite satisfactory. CONCLUSION. Lesions of long duration generally lose their characteristic histopathologic features, and HPV cannot be detected in these lesions by polymerase chain reaction. Therefore, multiple sections should be examined histopathologically, and extreme care should be taken in order to avoid misdiagnosis.