LAUSR

Dear Editor, Buschke-Lowenstein tumor (BLT) is a rare giant condyloma acuminatum of the anogenital region, first described by Buschke and Lowenstein as a potential malignant condyloma acuminatum. The incidence is estimated to be 0.1% in the general population. The disease affects men more frequently than women (ratio = 2.7:1); the mean age of onset is approximately 45 years. BLT usually emerges as a slowly growing cauliflower-like tumor of the anogenital region, which easily infiltrates the adjacent tissues. BLT is a sexually transmitted disease; human papillomavirus (HPV) is an important factor in its development. BLT is always preceded by anogenital warts, but just a few cases of condyloma acuminatum turn into BLT. Smoking, multiple sexual partners, anaerobic infections, local chronic inflammation, and immunodeficiency are possible risk factors. High recurrence rates after resection and elevated incidence of malignant transformation into an invasive squamous cell carcinoma are features of BLT. Wide surgery is considered the mainstay of treatment. A 64-year-old Moroccan man was referred to our dermatology department with a 10-year-history of a growing mass in the genital region. He denied a history of immunodeficiency syndromes. On physical examination, an extensive verrucous cauliflower-like mass was localized on inguinal folds, pubic region, penis and perineum (Figure 1). Inguinal lymph node palpation was normal. Routine blood tests and serological tests for syphilis, HIV, HBV, and HCV were negative. Histological examination of a intralesional biopsy specimen showed a moderate degree of dysplasia of the epithelium with koilocytosis atypia, acanthosis, and parakeratosis. PCR assay for HPV showed an infection with HPV Type 6. A diagnosis of giant condyloma acuminatum was made based on clinical and histopathological features. The patient underwent an abdominal-pelvic MRI scan that showed a genital mass with an intense contrast enhancement, without infiltration of deeper tissues. Inguinal lymph nodes were seen as reactive, nonmetastatic. We opted for a two-stage surgical procedure. The first stage consisted in tumor removal with clinically safe margins (Figure 2A) and positioning of an Integra Matrix Wound Dressing (Integra LifeSciences Corporation) (Figure 2B). Negative Pressure Therapy (VACUlta, KCl) was then applied as postoperative dressing to keep the matrix in position, without interrupting the silicone sheet (Figure 2C). The final histological report confirmed the bioptic diagnosis of BLT, with margins free of disease. After 3 weeks, the silicone top layer was removed (Figure 3A), and the second-stage reconstruction was performed. A thin splitthickness skin graft (0.3/0.45 mm) was harvested with electric