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Stock D et al. - A 49-year-old male presented with an atypical hyperkeratotic lesion at the distal aspect of the second toe with adjacent dystrophy of the nail plate. Radiographs, magnetic resonance images, and, finally, ultrasound images were used to confirm the presence of an underlying mass, and biopsy confirmed the diagnosis of granular cell tumor. Partial digital amputation was eventually undertaken. The authors feel that it is important for surgeons to maintain a high index of suspicion, particularly when a seemingly benign lesion, such as a hyperkeratosis, fails to respond as expected to treatment.

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