{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T13:57:01Z","timestamp":1776779821410,"version":"3.51.2"},"reference-count":9,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T00:00:00Z","timestamp":1776729600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Dermatopathology"],"abstract":"<jats:p>An 86-year-old man presented with a slowly enlarging, subject to chronic mechanical irritation, pedunculated keratotic papule on the plantar tip of the right hallux in the setting of severe peripheral arterial disease. Excision was deferred until after endovascular revascularization to reduce the risk of nonhealing and limb complications, after which the lesion was removed without wound sequelae. Histopathology demonstrated a conical papule with a central collagenous core and an overlying cap of compact hyperkeratosis. This case highlights key clinicopathologic features that distinguish acral keratotic tumors and underscores the importance of perfusion optimization when planning elective excision on an ischemic limb.<\/jats:p>","DOI":"10.3390\/dermatopathology13020018","type":"journal-article","created":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T11:42:45Z","timestamp":1776771765000},"page":"18","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Pedunculated Acral Keratotic Papule on an Ischemic Foot"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-5069-0945","authenticated-orcid":false,"given":"Janmesh D.","family":"Patel","sequence":"first","affiliation":[{"name":"Department of Dermatology, VA Northern California Health Care System, Sacramento VA Medical Center, 10535 Hospital Way, Mather, CA 95655, USA"},{"name":"Department of Dermatology, University of California Davis Medical Center, 4301 X St, Sacramento, CA 95817, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pooja A.","family":"Shet","sequence":"additional","affiliation":[{"name":"Department of Dermatology, VA Northern California Health Care System, Sacramento VA Medical Center, 10535 Hospital Way, Mather, CA 95655, USA"},{"name":"Department of Dermatology, University of California Davis Medical Center, 4301 X St, Sacramento, CA 95817, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8358-5061","authenticated-orcid":false,"given":"Sara E.","family":"Dahle","sequence":"additional","affiliation":[{"name":"Department of Dermatology, University of California Davis Medical Center, 4301 X St, Sacramento, CA 95817, USA"},{"name":"Podiatry Section, Surgical Services, VA Northern California Health Care System, Sacramento VA Medical Center, 10535 Hospital Way, Mather, CA 95655, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2315-8471","authenticated-orcid":false,"given":"Joshua M.","family":"Schulman","sequence":"additional","affiliation":[{"name":"Department of Dermatology, VA Northern California Health Care System, Sacramento VA Medical Center, 10535 Hospital Way, Mather, CA 95655, USA"},{"name":"Department of Dermatology, University of California Davis Medical Center, 4301 X St, Sacramento, CA 95817, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marat D.","family":"Kazak","sequence":"additional","affiliation":[{"name":"Podiatry Section, Surgical Services, VA Northern California Health Care System, Sacramento VA Medical Center, 10535 Hospital Way, Mather, CA 95655, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3S","DOI":"10.1016\/j.jvs.2019.02.016","article-title":"Global vascular guidelines on the management of chronic limb-threatening ischemia","volume":"69","author":"Conte","year":"2019","journal-title":"J. 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