Pain in the Toe: How It Came About

On the way home from my last trip to the Mohs surgery center, I said this little ditty to my boyfriend as we pulled out:

“When God gave out noses, I thought he said roses, so I said, “I’ll have one big red one.” I was trying to make light of a situation in which I had gone to the appointment expecting a procedure on my nose but instead got it on my toe. (Toes would have been a more consistent rhyme, but it really was “just” one toe).

The referral note said to work on my nose, but the doctor thought it said toes...Of course, she didn’t mistakenly tell the resident to cut into my toe, but it did seem like kind of an afterthought when I ended up getting a slice taken out of my left big toe.

An evaluation at the Mohs surgery center

My dermatologist had sent me there for the Mohs surgeon to look at three areas. This is the technical way of saying where they were, from my visit notes: (A) left posterior arm, (B) left posterior thigh, (C) nasal tip.

Evaluation results

If you read the results, sometimes they sound scarier than when your doctor tells you. They were:

• A. LEFT POSTERIOR ARM: Consistent with SQUAMOUS CELL CARCINOMA IN SITU with blunt-type invasion; extending to tissue edges.
• B. LEFT POSTERIOR THIGH: Consistent with SQUAMOUS CELL CARCINOMA IN SITU with blunt-type invasion; extending to tissue edges.
• C. NASAL TIP: Transected atypical squamous proliferation with superimposed cytological dysplasia (See NOTE).

NOTE: The findings could represent a superficial aspect of hypertrophic actinic keratosis or squamous cell carcinoma.

Freezing and topical treatment instead

Turns out, though, that I did NOT need Mohs. The surgeon said she wouldn’t have known without looking at me. Naturally, this was a relief. She froze the area behind my thigh and said to treat my face and arm with a combination of Efudex and calcipotriene, five days on my face and ten days on my arm.

Adding on a toe nail evaluation

We were just about finishing up when, almost as an afterthought, I asked if she could look at my left big toe. The non-technical way of describing this toe is: gross. It had a discolored stripe along one side and a hard-to-get-rid of fungus throughout. I have shown it to other doctors who haven’t thought much of it.

I might have damaged the nail bed through years of running. It got even worse, though, after a hike in the fall when I could feel it banging against my shoe.

Toe biopsy needed

She told the resident to cut part out for a biopsy: "just to make sure it isn't melanoma." THEN I got nervous. It was not a pleasant experience. It kept intermittently hurting. He had to reapply anesthesia. He was super nice and told me not to worry, he would tell me if he thought it was serious.

Back home, it hurt a lot when the anesthesia wore off. And when it came time to remove the big dressing, I had my boyfriend stand by in case I fell over. It was like a black hole with blood around it. I gingerly wiped the blood off. I did not fall over, though. It hurt for at least a week. I really needed to run, though, so I put two Band-Aids on and went a few miles.

A clear toe biopsy report

The resident was away when the biopsy report came back. He had a nurse call me because he knew I was worried. The nurse said it was not melanoma or any cancer at all, “just” a benign tumor. I had no idea what that was!

The nice resident called when he got back from vacation. He said it wasn’t even a tumor; it was a wart trying to grow under my toenail. It would take about nine months for the toenail to grow back. That was about a month ago, and I don’t see any action. It’s a good thing I’m not going to the beach.

My nose and the two other areas, by the way, cleared up after my home treatment.