A 45 year old man from South India had an asymptomatic verrucous plaque on the right palm with multiple haemorrhagic spots on the surface (fig 1) for the past three years. He also had a verrucous nodule on his left elbow. He gave a history of a reddish mass in both nostrils, which had recurred three times after excision in the past 15 years. At present he did not have any nasal lesions, but on examination of the oral cavity, a reddish polyp was observed hanging from the posterior surface of soft palate. Histopathological examination of the skin lesion was diagnostic (fig 2).

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Figure 1

Single verrucous lesion of the palm.

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Figure 2

Photomicrograph showing thick walled sporangia containing spores in the epidermis (haematoxylin and eosin × 200).