Management of cutaneous human papillomavirus infection: surgery

Surgical management is typically required when the clinician encounters an increased quantity of warts, large surface areas of affected, or when malignant transformation is suspected. Basic surgical techniques, such as cryosurgery, electrosurgery and surgical excision, are successful and relatively quick methods for removing warts and uncomplicated cutaneous malignancies. Mohs micrographic surgery is an amenable option when cutaneous malignancies are located in high-risk areas such as periocular or perinasal regions, lips, ears, digits and genitalia, tend to be larger in size, are recurrent, possess aggressive histological features, such as moderate-to-poor differentiation, or demonstrate perineural invasion. Situations involving a larger tumor burden, or requiring complicated surgical reconstruction in the operating room, may necessitate the assistance of plastic and reconstructive surgery. Herein, we describe treatment modalities employed in the surgical management of cutaneous human papillomavirus infection and include surgical teaching cases.