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The response to the question below was authored by Marc Mitnick DPM
Freckle on foot.
Freckle on bottom of foot - biopsied found to be "weird".
In February 2008 I had a biopsy on a freckle on the bottom of my left foot that I discovered a year and a half ago. The PA removed, or "punched" 5mm in the biopsy which resulted in 4 stitches. Treatment for recovery was a band-aid. Recovery was very painful as I was not told to stay off it I chased my three children around and ended up hurting ankle/knee/back as a result of walking funny for a week. When the results came back they said the freckle was not cancerous but "weird". They would like to remove twice the area around the original site. I am most concerned with their response to my questions regarding recovery and experience removing skin on the bottom of a foot. Apparently they will need to do both internal and external stitches and said it should be fine with a band-aid. This area of my foot gets stretched with each step. The site is near the ball of my foot in my arch about in inch in from the inside of the foot. What is your recommendation for recovery and response to this PA's advice?
You have to be very careful about excisions on the bottom of the foot. The number one concern is scarring and you are 100% correct that the "stretching" of the skin that you refer to could lead to scarring if not properly closed.
Depending on the actual location of the growth I sometimes keep my patients nonweightbearing for three weeks in order to prevent scarring.
At this point I would recommend the following:
1. Have another lab look at your biopsy slide because "weird" is not a diagnosis. I think you are entitled to a better explanation than that; it just tells me your PA did not research the actual diagnosis. Most of these types of biopsies come back as "dysplastic" which means noncancerous cells, but cells which are not normal either.
2. If you are going to need a wider excision this is not a job for a PA, I would recommend you see a podiatrist and if there is not one near you, I would recommend a plastic surgeon.
Marc Mitnick DPM
Johns Hopkins Medicine
University of Rochester Medical Center
American Academy of Pediatrics
Penn State Medical Center
National Institutes of Health
Columbia University Department of Rehabilitation
Stanford Health Care
Illinois Bone and Joint Institute
Mount Sinai Hospital
Institute for Chronic Pain
University of Florida Health
American Family Physician
University of Maryland Medical Center