Premalignant lesions

Author: Sarah Strickland, M.D. (see Authors page)

Revised: 26 July 2016, last major update July 2016

Copyright: (c) 2002-2016,, Inc.

PubMed Search: Condyloma [title]

Cite this page: Condyloma. website. Accessed October 28th, 2016.
Essential Features
  • Predominantly a sexually transmitted infection caused by human papillomavirus (HPV) and spread through oral, anal and genital sexual contact
  • Vertical transmission and autoinoculation also reported (Int J STD AIDS 1997;8:78, Arch Dis Child 2006;91:696)
  • Condyloma acuminata
  • Condyloma plana (flat)
  • Genital warts
  • Female: vulva, vagina, cervix, urethra, anal canal, perianal skin, crural folds
  • Male: penis, scrotum, urethra, anal canal, perianal skin, crural folds
Clinical Features
  • Flat, dome shaped, keratotic, pedunculated or cauliflower shaped
  • Singly or in clusters
  • White, skin colored, pink, purple, red or brown (Dermatol Online J 2006;12:5)
  • Most are asymptomatic but may exhibit symptoms of pruritus, burning or pain
  • May spontaneously regress (Am J Clin Pathol 1994;102:768)
  • Largely benign, but rarely associated with verrucous carcinoma, namely giant condyloma acuminata/Buschke-Lowenstein tumor (Vaccine 2008;26:K17)
  • Can be diagnosed by direct inspection withi bright light and magnification
  • Small lesions best appreciated with application of 3 - 5% acetic acid on colposcopic examination
  • Biopsy only recommended when lesions are unresponsive to therapy, ulcerated, show sudden growth, have increased pigmentation or are fixed to underlying structures (Clin Infect Dis 2002;35:S210)
  • Detection and typing of HPV not currently recommended for diagnosis
  • Podophyllotoxin, imiquimod (Aldara), sinecatechins, surgical excision, electrosurgical excision, cryotherapy, laser therapy
Clinical Images

Images hosted on other servers:

Severe case of external
genital warts on a female

Gross Images

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Micro Description
  • Acanthosis, dyskeratosis, parakeratosis, hyperkeratosis and a prominent granular layer
  • Superficial chronic inflammatory infiltrate in the dermis
  • Perinuclear cytoplasmic “halos” with “raisinoid” pyknotic nuclei or slightly enlarged nuclei (koilocytosis) in superficial epithelial cells
  • Binucleated and multinucleated squamous cells
  • Parabasal hyperplasia with accentuated intracellular bridges
  • Enlarged parabasal cells with foamy or ground glass nuclear chromatin
  • Regressing condylomas have increased stromal CD4+ T lymphoctyes (Am J Clin Pathol 1994;102:768)
  • May contain areas of intraepithelial neoplasia especially in immunosuppressed patients
Micro Images

Images hosted on other servers:

Genital wart

Flat condyloma

Condyloma acuminatum

Positive Stains
Differential Diagnosis