What is the next step in treating this patient’s lesion?

A 66-year-old female presented with a several month history of a slightly tender lesion on 1 sole that had been unsuccessfully treated initially as a clavus/corn and as a plantar wart. 

Which of these statements is true?

A. Plantar warts are stubborn and often resist therapy. Continued or more aggressive therapeutic options should be pursued.
B. Clavus/corns are persistent due to underlying mechanical stress that must be addressed by orthotics or surgery.
C. Amelanotic melanoma can present as a nonresolving papulonodular lesion that requires biopsy.
D. Foreign bodies are common on the sole and require surgical intervention.
E. Osteoma cutis can develop from repeated trauma, which will require surgical intervention to remove the lesion.

Answer—Case 3: All of the above

All of the above statements are correct. A punch biopsy was performed to establish the diagnosis, which was found to be osteoma cutis—most likely a result of repeated trauma. No foreign body was identified, so this was most likely secondary to a clavus/corn. When a lesion does not respond to appropriate therapy, it is not unreasonable to expand the differential diagnoses and extend diagnostic maneuvers to confirm the diagnosis.