Anorectal: Condyloma Acuminata

Basics

• Genital Warts from Contact of HPV-Containing Secretions Through Anal Epithelial Breaks
• Mostly Nonpainful but Can Itch or Bleed
• Types:
  • Cauliflower – Most Common
  • Flat
  • Dome
  • Keratotic
• Risk for Anal Intraepithelial Neoplasia (AIN) & Squamous Cell Carcinoma (SCC)

Human Papilloma Virus (HPV) Association

• HPV Types 6 & 11 – Low-Risk of Malignancy
  • Other Low-Risk Variants: 42,43,44
  • Accounts for 95% of Lesions
• HPV Types 16 & 18 – High-Risk of Malignancy Mn
  • Other High-Risk Variants: 31,33,35,39,45,51,52,56,58

Treatment

• Goal: Remove Macroscopic (Visible) Disease
• At-Home Tx:
  • Topical Tx: Podofilox, Imiquimod or 5-Fluorouracil (5-FU)
  • 40-60% Clearance Rate
• Office-Based Tx:
  • Topical Tx: Podophyllin or Trichloroacetic Acid (TCA)
  • Liquid Nitrogen Cryotherapy
  • 80-90% Clearance Rates
• Surgical Tx: Electrocautery/Fulguration or Excision
  • Indications: Extensive External Disease or Lesions in Anal Canal
    • If Circumferential: Staged Surgery (Prevent Stricture)
  • Dysplasia Does Not Require Wide Excision – Managed Similarly to Non-Dysplastic Condyloma
    • High Recurrence Rates with Unknown Benefit in Prevention

Buschke-Löwenstein Tumor (BLT/Giant Condyloma)

• Rare, Large, Slow-Growing, Ulcerative Lesion
• 50% Risk of Malignancy
• No Basement Membrane – Spreads Laterally with High Recurrence Rates
• Tx: Wide Local Excision
  • May Require APR if Extensive