Raised lesions on the ankles

A man in his 40s presented with a five year history of two painless, gradually enlarging, hyperkeratotic lesions on the lateral sides of the ankles (fig 1). He reported praying for approximately 50 minutes each day. The prayer posture involved kneeling and sitting on the dorsolateral aspect of the ankles. His feet were positioned parallel to each other, slightly apart, with weight equally distributed on both feet to maintain stability.bmj;383/oct05_3/e074383/F1F1f1Fig 1Hyperkeratotic plaques on the anklesPhysical examination showed two well demarcated, non-tender, hyperkeratotic plaques. Both were of similar size and thickness, distributed symmetrically on the ankles, anterior to the lateral malleoli. Dermoscopic examination (for a more in-depth assessment of the lesions), showed hyperkeratosis, without visible vessels or ulceration.QuestionsWhat are the differential diagnoses?What is the most likely diagnosis?How should this condition be managed?Answers1.What are the differential diagnoses?Differential diagnosis included callosities, warts, or squamous cell carcinoma. The site and bilateral nature of the…
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