Exophytic condyloma: are they as benign as we think?

Area of Science:

• Anorectal pathology
• Dermatology
• Oncology

Background:

• Anal dysplasia diagnosis and treatment remain controversial.
• Understanding lesion morphology is crucial for effective management.

Purpose of the Study:

• To evaluate the association between anal lesion type (flat vs. exophytic) and the grade of dysplasia.
• To assess the relationship between lesion morphology and patient factors.

Main Methods:

• Retrospective analysis of a prospectively collected pathological database (2009-2018).
• Inclusion of patients over 17 years old undergoing excision/biopsy for presumed anal condyloma or dysplasia.
• Comparison of patient demographics, lesion phenotype, and dysplasia grade.

Main Results:

• Analysis of 69 patients with 423 lesions; mean age 48.2 years, 62.3% male, 46.4% Black, 47.8% HIV-positive, 39.1% men who have sex with men (MSM).
• Exophytic lesions (55.3%) were 2.5-fold more likely to be associated with higher-grade dysplasia than flat lesions (41.6%).
• No association found between lesion type/severity and HPV, location, or patient characteristics (race, MSM, HIV status).

Conclusions:

• Exophytic anal lesions demonstrate a significantly higher likelihood of advanced dysplasia compared to flat lesions.
• Morphological assessment of anal lesions can inform patient counseling and guide the development of screening and treatment strategies for anal dysplasia.