Derm Dx: Bilobed Genital Nodule - Clinical Advisor

Derm Dx: Bilobed Genital Nodule

Slideshow

  • Slide

A 69-year-old man with a history of stasis dermatitis and actinic keratoses requests removal of a lesion on his penis. He states the growth has been present for at least 20 years and has significantly increased in size over the past year. He last engaged in sexual activity more than 7 years ago. Physical examination reveals a bilobed, flesh-colored nodule.

Can you diagnose this condition?

Condyloma acuminata, also known as anogenital warts, are caused by the human papillomavirus (HPV).1 More than 120 subtypes of the virus have been identified, with HPV-6 and HPV-11 responsible for the majority of clinical cases.2 HPV is one of the...

Submit your diagnosis to see full explanation.

Condyloma acuminata, also known as anogenital warts, are caused by the human papillomavirus (HPV).1 More than 120 subtypes of the virus have been identified, with HPV-6 and HPV-11 responsible for the majority of clinical cases.2 HPV is one of the most common sexually transmitted infections, with an estimated prevalence of anogenital HPV among adults aged 18 to 59 in the United States of 42.5%.3 Contact with an infected person, age, lifestyle, and immune status play a role in an individual’s susceptibility to overt infection.4,5  Certain subtypes of HPV, mainly HPV-16 and HPV-18, are oncogenic and cause cervical, anal, and oral cancers.2

Treatment options for condyloma acuminata include topical therapies such as podophyllotoxin and imiquimod, and in-office procedures including cryotherapy, electrosurgery, laser ablation, and surgical scissor excision. Vaccination for HPV is highly effective and recommended for children and young adults.4 By limiting transmission of oncogenic strains, an appreciable number of cancers will be prevented.6,7 

Stephen Schleicher, MD, is director of the DermDox Center for Dermatology, as well as an associate professor of medicine at Commonwealth Medical College and a clinical instructor of dermatology at Arcadia University and Kings College.

References

1.  Pennycook KB, McCready TA. Condyloma acuminata. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing;2019.  

2. Yanofsky VR, Patel RV, Goldenberg G. Genital warts: a comprehensive review . J Clin Anesthet Dermatol. 2012;5(6):25-36.

3. Prevalence of HPV in Adults Aged 18–69: United States, 2011–2014. Centers for Disease Control and Prevention website. https://www.cdc.gov/nchs/products/databriefs/db280.htm. Accessed November 7, 2019

4. O’Mahony C, Gomberg M, Skerlev M, et al.  Position statement for the diagnosis and management of anogenital warts. J Eur Acad Dermatol Venereol. 2019;33(6):1006-1019.  

5.  Kaderli R, Schnüriger B, Brügger LE. The impact of smoking on HPV infection and the development of anogenital warts. Int J Colorectal Dis. 2014;29(8):899-908.  

6.  Garland SM, Kjaer SK, Muñoz N, et al. Impact and effectiveness of the quadrivalent human papillomavirus vaccine: a systematic review of 10 years of real-world experience. Clin Infect Dis. 2016;63(4):519-527.

7.  Petry K-U, Bollaerts K, Bonanni P, et al. Estimation of the individual residual risk of cervical cancer after vaccination with the nonavalent HPV vaccine. Hum Vaccin Immunother. 2018;14(7):1800-1806.

Next hm-slideshow in Derm DX