61. Management of extensive benign condylomas in a seven year old

Abstract

<h3>Background</h3> Extensive condylomatous disease is a rare presentation in the Paediatric and Adolescent Gynaecological community. At present, there are no specific guidelines available on management. We present this case to describe our treatment modalities for one such patient. <h3>Case</h3> NG is a 7 year-old girl who presented to our service with extensive vulval condylomas. Her past medical history includes a diagnosis of hyperoxaluria type 1. This autosomal recessive condition affects 1-3 per million individuals and is associated with both liver and renal failure. In her case, NG required a liver transplant aged 1 year of age and a kidney transplant aged 3 years of age. She is on significant immunosuppressive therapy. NG initially presented to the dermatology service in March 2020 with a small lesion on the mons pubis. This did not respond to initial medical therapy including topical sinecatechins and podofilox. She was reviewed by the PAG service in July 2020. At this stage, her disease had spread significantly. It involved the clitoris, labia and peri-anal regions. The largest supra-clitoral lesion measured 4 × 2cm (Image 1). She had associated symptoms including dysuria and pruritus. She was commenced on Imiquimod 5% topical treatment, with a planned subsequent laser excision surgery. NG underwent laser excision and ablation of these lesions over two procedures due to the extensive nature of disease. In the first surgery August 2020, the largest anterior lesions were excised and we ablated the remaining lesions lateral to the vulva. This initial surgery was successful at removing the most significant disease around the clitoris, and the histopathology results confirmed the clinical findings as benign condylomatous disease. The subsequent surgery took place in October 2020. This mainly involved excision and ablation of the peri-anal lesions. This was successfully performed and we noted minimal recurrence from the first procedure (Image 2). <h3>Comments</h3> We present the case of NG, a 7-year-old girl diagnosed with extensive benign condylomas on a background of immunosuppressive therapy. Her two surgeries have been effective at treating her extensive disease The literature available suggests that this is a rare presentation in this age group. Laser excision is an effective treatment in an older adult population, and appears to be effective for this patient. Continuing ongoing management may require repeated surgical procedures.