648 Dermoscopic findings and HPV genotypes of genital keratotic lesions: Bowenoid papulosis, seborrheic keratosis, and condyloma acuminatum

Abstract

Dermatologists often encounter keratotic lesions in the genital area. Although making a clear diagnosis can be difficult, it is important for the treatment and prognosis closely related to the patient's quality of life. Dermoscopy has proven to be a useful, non-invasive tool. However, there is still a lack of dermoscopic data comparing bowenoid papulosis (BP), seborrheic keratosis (SK), and condyloma acuminatum (CA). More than 40 human papillomaviruses (HPV) genotypes infect the genital area and manifest as various intraepithelial neoplasms. This study is conducted to find distinctive dermoscopic features and HPV genotype distribution of BP, genital SK, and CA. Dermoscopically, glomerular vessels were predominant in BP that appeared in 7 cases (70.0%). Hairpin vessels were the most common vascular structures that accounted for 12 cases of CA (66.7%). SK was the least vascular-patterned disease as no vessel was observed in eight cases of SK (66.7%). Mucosal pigmentation was observed in 6 cases (60.0%) of BP. Seven cases of BP (70.0%) were classified into 'flat'. SK showed cerebriform appearance in seven cases (58.3%). Most CA cases had knob-like or finger-like appearance and whitish halo. All of BP ad CA presented positive results in HPV DNA detection, while seven cases (58.3%) of SK had positive results. For the high-risk genotype, principally HPV 16, BP showed the highest detection rate with 90.0%. SK and CA showed 58.3% and 44.4%, respectively. For the low-risk genotype, principally HPV 6 followed by HPV 11, CA presented the highest detection rate, with 88.9%. BP and SK showed 40.0% and 8.3% detection rate, respectively. The coexistence of the high-risk and the low-risk HPV was seen in three cases (30.0%) of BP, one case (8.3%) of SK, and six cases (33.3%) of CA. Dermoscopy can be useful for differentiating the entity of genital keratotic lesions ahead of an invasive method and a physician should consider the morphologic plasticity of HPV-related keratosis in the genital area or the genital wart in the expanded concept.