Verrucous psoriasis: A rare variant of psoriasis masquerading as verrucous carcinoma

Verrucous psoriasis (VP) is a rare variant of psoriasis characterized by hyperkeratotic, papillomatous plaques that clinically resemble verrucous carcinoma (VC) in lesion appearance and distribution.1, 2 It is amenable to medical treatments.3, 4, 5 Conversely, VC, a rare subtype of well-differentiated squamous cell carcinoma, is treated with surgical excision.1 Histologically, they may be difficult to differentiate. Ancillary positive p16 staining can help confirm a diagnosis of VC in equivocal cases. When diagnosing VC, it would be beneficial to consider a differential diagnosis including VP, verruca vulgaris, deep fungal infection, leishmaniasis, and hypertrophic lichen planus, which are responsive to medical treatment. Early consideration of medical therapy in uncertain cases could aid in the avoidance of unnecessary procedures and their complications. We present a patient with VP of the heel that was initially diagnosed as VC and excised. Recovery was complicated by graft breakdown and poor wound healing over 2 years.