Editing Anal condylomata


== '''Condyloma Acuminatum''' (anal wart) ==

* Caused by HPV, especially     subtypes 6, 11, 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 69, 82     (90% of condyloma are from subtypes 6 and 11, which are typically benign     lesions; serotypes 16 and 18 are more commonly seen with dysplasia and     malignancy)
* Generally regarded as     premalignant
* Presentation
** Larger disease burden can      have pruritis, bleeding, burning, tenderness, discharge, pain
** Application of 5% acetic      acid causes lesions to turn white - can aid in identification
** Giant condyloma acuminata -      size definitions vary, but very big lesions need total excision with 1cm      margin as they likely harbour SCC
**
* Differential diagnosis
** Benign skin tags
** Hypertrophic anal papillae
** Molluscum contagiosium
** Seborrheic keratoses
** Hypertrophied sebaceous      glands
** Conyloma lata (secondary      syphilis)
** Dysplastic nevi
** Anal cancer
* Histopathology
** Verrucous architecture      composed of papillary excrescences and hyperkeratosis, with koilocytic      changes within a maturing squamous epithelium
* Workup
** Large lesions (1-2cm at      base) should be referred to a surgeon
** Women should have a pap      smear too
** Check for chlamydia,      gonorrhoea, HIV
* Intervention - most patients     require intervention
** Goal of treatment is      complete destruction of all condyloma
** Approach:
*** <1cm warts: anything       will work well, but cryotherapy or electrosurgical excision are the       quickest and easiest, whereas patient-applied topical things will be       slower
*** >1cm:
**** Probably best with        surgical excision
**** EUA with excisional        biopsies and fulguration of remaining lesions
**** If carpeting is present        with minimal intervening normal skin, better to stage treatment to        minimise anal scarring and stenosis
**** Treat individual        recurrences in clinic with topical therapy
**** 20-50% recurrence        regardless of modality
** Topical
*** Response rates ~50%, better       with smaller lesions
*** Podophyllotoxin
**** Rarely used - local        toxicity
*** Imiquinod
*** 5-flourouacil -       patient-applied
*** Trichloroacetic acid -       physician-applied
*** Sinecatechins
**

== '''Verrucous     carcinoma'''     (Buschke-Lowenstein tumour or giant condyloma) ==

** Rare, slow-growing
** Intermediate form between      the above and SCC
** Tend to local invasion      rather that metastasis
** Can complicate with abscess      or fistula
** If involving sphincter: most      likely APR
** If not involving sphincter:      wide local excision +/- flap closure

[[Category:Colorectal]]