Penile Squamous Cell Carcinoma Masquerading as Giant Condyloma.

We present the case of a 59-year-old male, who presented with a recurrent and rapidly enlarging giant condylomatous lesion involving the entire penile shaft with extension to the anterior scrotum. The patient had been free of disease for several years, until 2 months before clinic presentation. The lesion was associated with tenderness and malodorous discharge (Fig. 1).

Fig. 1.

Giant penoscrotal condyloma.

Incisional biopsies obtained from multiple sites indicated the diagnosis of condyloma acuminata without the evidence of associated squamous cell carcinoma. Furthermore, immunohistochemical studies revealed positivity for Human Papillomavirus low–risk subtypes in the epidermis. Following a multidisciplinary evaluation by Urology and Plastic Reconstructive Surgery services, the patient elected to proceed with a glans-sparing, wide local excision of involved penile shaft and scrotal lesions. Reconstruction of the residual defect was performed with a combination of split-thickness skin graft and adjacent tissue transfer. Final surgical pathology, however, revealed a well-differentiated squamous cell carcinoma, condylomatous type, arising in a background of condyloma acuminatum with a focus of superficial invasion. All margins (peripheral and deep) were free of carcinoma. No additional surgical treatment was deemed necessary. The patient recovered uneventfully with a successful and functional reconstructive result and has remained free of recurrence (Fig. 2).

Fig. 2.

Long term result with evidence of well healed skin graft reconstruction and suspension of pubic skin, in order to also address buried penis pathology.

Penile squamous cell carcinoma is a rare malignancy and represents approximately 0.5% of malignant pathologies in male patients.[1] Risk factors include HPV exposure, phimosis, and chronic inflammatory conditions such as lichen sclerosis. HPV-16 subtype has the highest prevalence in invasive penile tumors.[1] In locally advanced cases, a multidisciplinary approach, with the aim of complete and margin negative resection with organ preservation—when feasible—combined with immediate reconstruction of the acquired soft-tissue defect with split-thickness skin graft and adjacent tissue transfer has been proven to be both efficient and safe treatment modalities.[2] Careful bolster dressing application, along with minimization of shear forces, is of key importance for successful reconstruction.

In conclusion, we would like to emphasize the need to maintain a high index of suspicion for underlying squamous cell carcinoma in the management of giant condylomata. A multidisciplinary team approach including urology, plastic and reconstructive surgery, and pathology will optimize both oncological outcomes and the benefits of a functional reconstruction.