Human papillomavirus (HPV) is a non-enveloped, double-stranded DNA virus associated with a wide range of benign and malignant lesions affecting mucocutaneous surfaces. Although the oncogenic role of HPV in anogenital and oropharyngeal cancers is well-established, HPV-associated squamous cell carcinoma (SCC) arising in the extremities, particularly the toes, remains exceedingly rare. We report the case of a 78-year-old female farmer who presented with a persistent lesion between the fourth and fifth toes of her right foot, present for more than 1 month. Physical examination revealed a mildly purulent, horn-like lesion in the interdigital space. Magnetic resonance imaging (MRI) demonstrated a 37 × 17 mm enhancing soft tissue mass suggestive of an inflammatory phlegmon with possible underlying osteomyelitis. Given the clinical and radiological findings, surgical amputation with wide debridement was performed. Histopathological examination revealed a well-differentiated SCC extending to, but not invading, the underlying bone. Surgical margins were negative. HPV DNA typing and cytologic evaluation confirmed the detection of HPV type 6, a low-risk subtype. This case highlights the importance of considering malignancy in chronic, wart-like lesions of the foot, especially in patients with occupational exposure. HPV-associated verrucous SCC, although rare, should be recognized to ensure accurate diagnosis and appropriate surgical management.

henwa El Dakdouki, MD, is a Lebanese physician and academic specializing in Internal Medicine and Infectious Diseases. She is associated with Hammoud Hospital University Medical Center (HHUMC), Lebanon, where she serves as Associate Professor of Internal Medicine and Head of the Internal Medicine Department, Infectious Diseases Division, and Infection Control Department.

She completed her general medical training at Lebanese University and fellowship training in Infectious Diseases at the American University of Beirut Medical Center (AUBMC). She also received specialized training in systemic diseases at Claude Huriez Hospital in Lille, France, a certificate in molecular biology from Saint Joseph University (USJ), and a diploma in hospital management.

Dakdouki has contributed to the development of Infectious Disease and Infection Control divisions in hospitals in southern Lebanon and has participated in teaching programs at Lebanese University, Beirut Arab University, and University of Balamand. She has published research in national and international journals and has authored/co-authored books.