Multiple epidermolytic acanthomas must not be confused with genital human papillomavirus infection

We describe two patients with multiple epidermolytic acanthomas on the scrotum initially referred to our clinic as genital warts. Both patients presented with multiple tan-colored warty papules scattered on the scrotal skin. Biopsy revealed hyperkeratosis, hypergranulosis, and clear cell changes consistent with epidermolytic acanthoma. Human papillomavirus was not detected and the lesions cleared rapidly with a liquid nitrogen cryoprobe. Despite only a few reports of multiple epidermolytic acanthomas of the scrotum, it may not be as rare as previously thought. In addition, genital localization of the wart-like lesions may lead to confusion with other conditions such as condylomata acuminata, molluscum contagiosum, or bowenoid papulosis.