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The outer skin of the little lump is decapitated with a needle, revealing a small thorn. Then the rest of the spines are "combed" with the needle, scratching the skin. 
At some point, it will start to bleed. Use a nail clipper or similar to remove as many raised spines (or bits of them) as you can.
The work is not finished. We can see the granuloma. Each small granule contains a spine (smaller than the one already extracted). For comparison, the common wart next to it has the same pattern and size. Different disease or just different skin/wound depth?
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