A 72-year-old woman presents for evaluation of stasis dermatitis. The patient reports that she has been a smoker throughout her adult life, has chronic obstructive pulmonary disease, and multiple other medical conditions. On examination, a protuberant growth centered above her upper lip is noted. The patient states that the lesion has been present for “quite some time” and does not cause any discomfort. No similar lesions are noted elsewhere on her body.
Submit your diagnosis to see full explanation.
Verruca vulagris (warts) are among the most common growths encountered by physicians.1 Classic sites of these lesions include the fingers, the dorsal surface of hands, the soles of feet (plantar verrucae), and genitalia (condyloma). Verrucae result from an infection of human papillomavirus (HPV), of which some 200 distinct genotypes have been identified.2 HPV infects basal epithelial cells, resulting in keratinocyte proliferation. Several subtypes are carcinogenic and have been linked to a number of cancers such as those involving the head and neck.3
For the majority of immunocompetent individuals, verrucae are self-limited. In a study of schoolchildren with warts, half of the children experienced full resolution of the warts without treatment within 1 year.4 Warts require treatment if they are painful, or for cosmetic excision.
A variety of therapeutic options are available; choice of a modality depends on a number of factors including location, extent of lesion, duration, patient age, and potential discomfort.5 Many over-the-counter remedies contain salicylic acid. Destructive methods entail physical or chemical removal of the affected tissue. Both liquid nitrogen cryosurgery and lasers are widely used. Persistent verrucae may respond to intralesional bleomycin or immunotherapy with Candida antigen.5
Stephen Schleicher, MD, is director of the DermDox Center for Dermatology in Pennsylvania, as well as an associate professor of medicine at Commonwealth Medical College and a clinical instructor of dermatology at Arcadia University and Kings College.
1. Thompson TT, Feldman SR, Fleischer Jr AB. Only 33% of visits for skin disease in the US in 1995 were to dermatologists: is decreasing the number of dermatologists the appropriate response? Dermatol Online J. 1998;4(1):3.
2. Graham SV. The human papillomavirus replication cycle, and its links to cancer progression: a comprehensive review. Clin Sci (Lond). 2017;131(17):2201–2221.
3. Gillison ML, Chaturvedi AK, Anderson WF, Fakhry C. Epidemiology of human papillomavirus-positive head and neck squamous cell carcinoma. J Clin Oncol. 2015;33(29):3235-3242.
4. Bruggink SC, Eekhof JA, Egberts PF, van Blijswijk SC, Assendelft WJ, Gussekloo J. Natural course of cutaneous warts among primary schoolchildren: a prospective cohort study. Ann Fam Med. 2013;11(5):437-441.
5. Abeck D, Tetsch L, Lüftl M, Biedermann T. Extragenital cutaneous warts – clinical presentation, diagnosis and treatment. J Dtsch Dermatol Ges. 2019;17(6):613-634.